Fill and Sign the Waiver Release Lien Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ___________________ Company: ___________________ Address: ____________________ City: ___________________ State: _____ Zip: __________ Phone: _________________ Fax: __________________ Reference # ___________________ UNCONDITIONAL WAIVER AND RELEASE OF LIEN UPON FINAL PAYMENT On this _____ day of ________________ , 20 ______ , the undersigned lienor, whose address is ______________________________________________________________________ , in consideration of the final payment in the amount of $ __________________ , hereby waives and releases 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 property located at and described as: ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ . ______________________________ Signature of Lien Holder _____ _________________________ Type or Print Name Unconditional Waiver and Release of Lien Upon Final Payment Page 1 of 2 STATE OF WASHINGTON COUNTY OF ___________________ On this day personally appeared before me _______________________________ , to me known to be the individual(s) described in and who executed the within and foregoing instrument, and acknowledged that he/she/they signed the same as his/her/their free and voluntary act and deed, for the uses and purposes therein mentioned. Given under my hand and seal of office this _____ day of _____________ , 20 _________ . ______________________________ Notary Public residing at _________ Printed Name: _________________ My Commission Expires: ___________________ Unconditional Waiver and Release of Lien Upon Final Payment Page 2 of 2