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Fill and Sign the Oregon Unconditional Waiver and Release of Claim of Lien Upon Progress Payment Form

Fill and Sign the Oregon Unconditional Waiver and Release of Claim of Lien Upon Progress Payment Form

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Unconditional 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: ________________________________________________________________________ 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: ________________________________________________________________________________________________________________________________________________ ________________________________________________________________________ _________________(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 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 Page 2 of 2STATE OF OREGONCOUNTY OF _________________ This instrument was acknowledged before me on _______________________ (date) by __________________________________________ (name(s) of person(s)). ______________________________ NOTARY PUBLIC Print Name: ___________________ My Commission Expires: ____________________

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