Fill and Sign the New Jersey Waiver Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ___________________ Company: ___________________ Address: ____________________ City: ___________________ State: _____ Zip: __________ Phone: _________________ Fax: __________________ UNCONDITIONAL WAIVER AND RELEASE OF LIEN UPON FINAL PAYMENT On this _____ day of ________________ , 20 ______ , the undersigned lienor, in consideration of the final payment in the amount of $ __________________ , hereby waives and releases 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: ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ __________________________________ Signature of Lien Holder _____ _____________________________ Type or Print Name Unconditional Waiver and Release of Lien Page 1 of 2 State of New Jersey County of ________________ , ss: I CERTIFY that on _______________ , __________ , _________________________________ personally came before me and acknowledged under oath to my satisfaction, that this person (or if more than one, each person): a) is named in and personally signed the attached document; and b) signed and delivered this document as his/her/their act and deed; and c) executed this document under oath after being duly sworn. _____________________________ Signature ______________________________ Notary Public Print Name: ___________________ My commission expires: ________________ Unconditional Waiver and Release of Lien Page 2 of 2