Fill and Sign the Waiver of Lien by Individual Pennsylvania Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: _____________________ Company: ___________________ Address: _____________________ City: __________________ State: _______ Zip: __________ Phone: ________________ Fax: ________________ UPI Number: ________________ Stipulation Against Liens -- Individual (Pa. Stat. Ann. tit 49, § 1401) COMES NOW, __________________________________ , as a contractor or subcontractor providing labor and/or materials for the alteration, repair, erection, or construction of the property located at and described as _______________________________________________________________________ (address should include municipality, ward (if in the city of Pittsburgh), county and state), and would state as follows : 1. The undersigned hereby expressly waives the right to file a lien claim against the above-described property. 2. The total contract price between the owner and the contractor is less than One Million Dollars ($1,000,000.00) 3. Further, if the undersigned is the general contractor for the project, said waiver of lien claim is a waiver by anyone to file a lien claim and shall also be binding upon subcontractors if such subcontractors have been given actual notice before any labor or materials were furnished by the subcontractors, or if this Stipulation Against Liens was filed in the office of the prothonotary prior to the commencement of the work upon the ground, within ten (10) days after the execution of the principal contract, or not less than ten (10) days prior to the contract with the claimant subcontractor, indexed in the name of the contractor as defendant and the owner as plaintiff and also in the name of the contractor as plaintiff and the owner as defendant. 4. The undersigned contractor or subcontractor began or will begin supplying labor and/or materials for the alteration, repair, erection, or construction of the above described property on or about the _____ day of _____________ , 20 ______ . This the _____ day of _____________ , 20 _________ . Stipulation Against Liens Page 1 of 2 ______________________________ Signature _____ _________________________ Type or Print Name Acknowledgment of Individual COMMONWEALTH OF PENNSYLVANIA COUNTY OF ____________________ On this, the _____ day of _____________ , 20 _______ , before me a notary public, 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 executed the same for the purposes therein contained. In witness hereof, I hereunto set my hand and official seal. ___________________________ Notary Public ___________________________ Printed Name (Stamp or Seal) ________________ My Commission Expires: ________________ Stipulation Against Liens Page 2 of 2