Fill and Sign the Oregon Lien 481374224 Form

Conditional Waiver and Release of Lien Page 1 of 2Prepared by, recording requested by and return to:Name: ___________________Company: ___________________Address: ____________________City: ___________________State: _____Zip: __________Phone: _________________Fax: __________________----------------------Above this Line for Official Use Only---------------------Name of Claimant: ________________________________Name of Debtor: ________________________________Amount of Lien: _________________Tax Assessor’s Account Number: _________________Situs Address of Real Property: ________________________________________________________________________CONDITIONAL WAIVER AND RELEASE OF LIEN UPON FINAL PAYMENTOn this _____ day of ________________ , 20______, the undersigned lienor, whose address is ______________________________________________________________________, 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 property located at and described as: ________________________________________________________________________________________________________________________________________________ _______________________________________________________________________ (legal description that includes a metes and bounds description; a lot, block, subdivision; the book and page and/or instrument number of a recorded deed where the legal can be found; or a parcel in a partition). This Conditional Waiver and Release of Lien Upon Final 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 covers the final payment to the undersigned for all labor, services, equipment, or material furnished on the job. Before any recipient of this document relies on it, the party should verify evidence of payment to the undersigned. Conditional Waiver and Release of Lien Page 2 of 2 ______________________________ Signature of Lien Holder ______________________________ Type or Print Name STATE OF OREGONCOUNTY OF _________________ This instrument was acknowledged before me on _______________________ (date) by __________________________________________ (name(s) of person(s)). ______________________________ NOTARY PUBLIC Print Name: ___________________ My Commission Expires: ____________________