Fill and Sign the New York Lien 497321343 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 PROGRESS PAYMENT On this _____ day of ________________ , 20 ______ ,the undersigned lienor, whose address is ______________________________________________________________________ , in consideration of the sum 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 property located at and described as: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _________________ . 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 Unconditional Waiver and Release of Lien Upon Progress Payment Page 1 of 2 STATE OF NEW YORK COUNTY OF ___________________ On the ____________ day of _________________ in the year __________ before me, the undersigned, personally appeared _____________________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity (ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________ Unconditional Waiver and Release of Lien Upon Progress Payment Page 2 of 2