Fill and Sign the Receipt and Waiver of Mechanics Lien Rights Form

FORM NO 120-M – Uniform Conveyancing Blanks RECEIPT AND WAIVER OF MECHANIC’S LIEN RIGHTS Dated: _________________, 20_____ The undersigned hereby acknowledges receipt of the sum of $_______________________________ CHECK ONLY ONE 1) _ as partial payment for labor, skill and material furnished 2) _ as payment for all labor, skill and material furnished or to be furnished (except the sum of $_________retainage or holdback) 3) _ as full and final payment for all labor, skill and material furnished or to be furnished to the following described real property: (legal description, street address or project name) and for value received hereby waives all rights acquired by the undersigned to file or record mechanic’s liens against said real property for labor, skill or material furnished to said real property only (only for the amount paid if Box 1 is checked and except for retainage shown if Box 2 is checked). The undersigned affirms that all material furnished by the undersigned has been paid for, and all subcontractors employed by the undersigned have been paid in full, EXCEPT: ___________________________________________________ By________________________________________________ _ ___________________________________________________ Title ___________________________________________________ (Address) NOTE: If this instrument is executed by a corporation, it must be signed by an officer, and if executed by a partnership, it must be signed by a partner. 1 FORM NO 120-M – Uniform Conveyancing Blanks 2