Fill and Sign the Services or Materials Furnished through 20 to Form

Conditional Waiver and Release of Lien Page 1 of 2After Recording Return to:________________________________________________________________________________________________))))))))--------Above This Line Reserved For Official Use Only---------------- CONDITIONAL WAIVER AND RELEASE OF LIEN UPON FINAL PAYMENT- INDIVIDUAL The undersigned lienor, in consideration of the final payment in the amount of $ __________________, hereby waives and releases its 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 following described property: ____________________________________________________________________________________________________________________________________________________________ _____________________________________________________________________________.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.DATED on _____ day of ___________________ , 20 _____.Lienor's Name _________________________Address _______________________________By _________________________Printed Name __________________________ Conditional Waiver and Release of Lien Page 2 of 2STATE OF ___________ COUNTY OF _____________ Sworn to (or affirmed) and subscribed before me this _____ day of _________________, 20______ by _________________________ (name of person making statement) who is personally known to me or produced _________________________ as identification, and who did take an oath.____________________________ NOTARY PUBLICPrinted Name of Notary _________________________Commission Expires _________________________