Fill and Sign the Partial Conditional Waiver Michigan Form

PARTIAL CONDITIONAL WAIVER OF LIEN--INDIVIDUAL (M.S.A. § 570.1115(9)(b)) I/we, __________________________________ , have a contract with ________________________________________________ to provide _____________________________________________ (description of work and/or materials) for the improvement to the property described as _______________________________________________________________________ , and by signing this waiver waive my/our construction lien to the amount of $ ______________ , for labor/materials provided through the _____ day of ________________ , 20 _______ . This waiver, together with all previous waivers, if any, does/ does not cover all amounts due to me/us for contract improvement provided through the date shown above. This waiver is conditioned on actual payment of the amount shown above. If the improvement is provided to property that is a residential structure and if the owner or lessee of the property or the owner's or lessee's designee has received a notice of furnishing from me/one of us or if I/we are not required to provide one, and the owner, lessee, or designee has not received this waiver directly from me/one of us, the owner, lessee, or designee may not rely upon it without contacting me/one of us, either in writing, by telephone, or personally, to verify that it is authentic. This the _____ day of ______________ , 20 _______ . ________________________ Lien Claimant _____ ___________________ Type or Print Name _____ ___________________ ________________________ Address _____ ___________________ Telephone DO NOT SIGN BLANK OR INCOMPLETE FORMS. RETAIN A COPY . MI § 570.1115 Partial Conditional Waiver of Lien Page 1 of 1