Fill and Sign the On This Day of 20 the Undersigned Lienor in Form

Conditional Waiver and Release of Lien Page 1 of 1 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 MONTANA COUNTY OF _____________________ The instrument was acknowledged before me on ___________________ (date), by _________________________________________ (name(s)). ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________