Fill and Sign the Washington Payment Form

Unconditional Waiver and Release of Lien Upon Final Payment Page 1 of 2 Prepared by, recording requested by and return to: Name: ___________________ Company: ___________________ Address: ____________________ City: ___________________ State: _____ Zip: __________ Phone: _________________ Fax: __________________ Reference # ___________________ ----------------------Above this Line for Official Use Only--------------------- 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 2 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: ___________________