Fill and Sign the Waiver and Release for Specific Payment the Form

Conditional Waiver and Release of Lien Upon Progress Payment Page 1 of 2 Conditional Waiver and Release of Lien Upon Progress Payment - Corporation On this _____ day of ________________ , 20 ______ , the undersigned , as representative of ___________________________________ a ___________________________________ corporate lienor, in consideration of the sum of $ ______________ _____ , does hereby waive and release 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 U pon 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. DATED on _____ day of ____________________ , 20 _____ . __________________________________ Signature _____ _____________________________ Type or Print Name Title Corporation Conditional Waiver and Release of Lien Upon Progress Payment Page 2 of 2 STATE OF MAINE COUNTY OF __________________ The foregoing instrument was acknowledged before me this _____________________ (date) by _________________________________________ (name of officer or agent, title of officer or agent) of _____________________________ (name o f corporation acknowledging) a _____________________________________ (state or place of incorporation) corporation, on behalf of the corporation. ___________________________________ Signature of Notary Public ___________________________________ Name of Notary Public Notary Public, State of Maine My commission expires: ____________________