Fill and Sign the This Conditional Waiver and Release of Lien Upon Progress Payment is Form

Conditional Waiver and Release of Lien Page 1 of 2Prepared by, recording requested by and return to:Name: _____________________Company: _____________________Address:_______________________ City: ____________________State: _____Zip: _________Phone: _________________Fax: ___________________UPI Number: ________________----------------------Above this Line for Official Use Only--------------------- 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: ________________________________________________________________________________________________________________________________________________ ___________________________________________________________________. 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 Page 2 of 2State of South DakotaCounty of __________________On this ______ day of __________________ , 20______, before me, ______________________________, the undersigned officer, personally appeared ______________________________, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument and acknowledged that he/she executed the same for the purposes therein contained.In witness whereof I hereunto set my hand and official seal.Notary Public, State of My commission expires: Type or Print Name