Fill and Sign the Waiver Construction Form

Waiver of Construction Lien The undersigned       , a corporation organized and (Name of Corporation waiving lien) existing under the laws of the state of       , with its principal office (Name of State) located at       , referred to herein as the Company, (Street Address, City, County, State, Zip Code) have contracted (the Contract ) with       (Name of Owner, Contractor, Materialmen, etc.) to provide       in connection with (Work, Services, Materials, Equipment) certain improvements to real property owned by       , (Name of Owner) located at       , and more particularly described in (Street Address, City, County, State, Zip Code) Exhibit A attached hereto and made a part hereof by reference. For and in consideration of the sum of $       and other good and valuable consideration, the receipt of which is acknowledged, the undersigned Company expressly waives any right it now has, or in the future will have, to a construction lien against the real property described in Exhibit A on account of       (Work, Services, Materials, Equipment) provided by Company under the Contract described above . WITNESS our signature on this the       day of       , 20       .       (Name of Company Waiving Lien) By: (Signature of Officer)       (P rinted Name and Title of Officer) (Acknowledgment Form may vary by State) STATE OF       COUNTY OF       Personally appeared before me, the undersigned authority in and for the said county and state, on this       day of       , 20       , within my jurisdiction, the within named       , who acknowledged that he is       (Name of Officer) (Name of Office) Waiver of Construction Lien Page 1 of 2 of       , a       corporation, and that (Name of Corporation) (Name of State) for and on behalf of the said corporation, and as its act and deed he executed the above and foregoing instrument, after first having been duly authorized by said corporation so to do. ________________________________ NOTARY PUBLIC My Commission Expires: ________________ Waiver of Construction Lien Page 2 of 2