Fill and Sign the New Hampshire Release Form

CONDITIONAL WAIVER AND RELEASE OF LIEN UPON PROGRESS PAYMENT On this _____ day of ________________ , 20 ______ , the undersigned lienor, in consideration of the sum of $ ___________________ , does hereby waive and release his or her lien and right to claim a lien for labor, services or materials furnished through __________________ , 20 _____ , to __________________________ (customer) on the job of ____________________________________ (owner of property) to the following described property: ________________________________________________________________________ ________________________________________________________________________ ___________________________________________________________________ . This Conditional Waiver and Release of Lien Upon Progress Payment is conditioned upon the undersigned receiving collected funds in the amount of $ _______________ for the work described herein. Should these funds not be received within _____ days of the date hereof, this Conditional Waiver and Release of Lien is void. This waiver and release does not cover any retention or labor, services, or materials furnished after the date specified. __________________________________ Signature of Lien Holder _____ _____________________________ Type or Print Name STATE OF NEW HAMPSHIRE COUNTY OF _____________________ The instrument was acknowledged before me on ___________________ (date), by _________________________________________ (name(s) of persons). ______________________________ Signature of Notarial Officer (Seal, if any) Printed Name: _________________ Title and Rank:_________________ My Commission Expires: Conditional Waiver and Release of Lien Page 1 of 2 _____________________ Conditional Waiver and Release of Lien Page 2 of 2