Fill and Sign the Release Lien Payment 497430666 Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: _____________________ Company: _____________________ Address: _______________________ City: ____________________ State: _____ Zip: _________ Parcel ID Number: ______________ Phone: _________________ Fax: _________________ CONDITIONAL 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 $ ___________________ , 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 property located at and described as: ________________________________________________________________________ ________________________________________________________________________ ___________________________________________________________________ (legal description should include t he platting information (if property is platted), or if unplatted, then "metes and bounds" tied into the Public Land Survey System; Public Land Survey Information; municipality (e.g Town, Village or City of Paradise); and county). 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 Conditional Waiver and Release of Lien Upon Progress Payment Page 1 of 2 This instrument was drafted by _______________ (name). STATE OF WISCONSIN COUNTY OF ________________ This instrument was acknowledged before me this _____ day of ________________ , 20 _____ by _________________________________ . ______________________________ Notary Public (Seal, if any) Printed Name: _________________ My Commission Expires: _________________ Conditional Waiver and Release of Lien Upon Progress Payment Page 2 of 2