Fill and Sign the Whereas the Undersigned Has Been Employed by to Furnish Form

WAIVER OF LIEN TO DATE STATE OF ILLINOIS Gty #___________________________________COUNTY OF ____________________Loan #___________________________________TO WHOM IT MAY CONCERN:WHEREAS the undersigned has been employed by ___________________________________ to furnish ___________________________________for the premises known as _____________________________________________________________________________________________of which __________________________________ is the owner. The undersigned, for and in consideration of ___________________________________ ($______________._____) Dollars, and other good and valuable consideration, the receipt whereof is hereby acknowledged, do(es) hereby waive and release any and all lien or claim of, or right to, lien, under the statutes the State of Illinois, relating to mechanics' liens, with respect to and on said above-described premises, and the improvements thereon, and on the material, fixtures, apparatus or machinery furnished, and on the moneys, funds or other considerations due or to become due from the owner, on account of labor, services, material, fixtures, apparatus or machinery heretofore furnished, or which may be furnished at any time hereafter, by the undersigned for the described premises.Given under my hand and seal this _____ day of ________________ , 20 _____. Signature and Seal: NOTE: All waivers must be for the full amount paid. All waivers should be considered void if valid proof of full payment for contracted work not present. If waiver is for a corporation, corporate name should be used, corporate seal affixed and title of officer signing waiver should be set forth; if waiver is a partnership, the partnership name should be used, partner should sign and designate himself as partner.--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- CONTRACTOR'S AFFIDAVIT STATE OF ILLINOISCOUNTY OF __________________TO WHOM IT MAY CONCERN: THE undersigned, being duly sworn, deposes and says that he is ____________________________ of the ____________________________ who is the supplier for the _____________________________ on the building located at ________________________________________________________________ owned by _________________________________. That the total amount of the contract including extras is $____________ on which he has received payment of $_____________ prior to this payment. That all waivers are true, correct and genuine and delivered unconditionally and that there is no claim either legal or equitable to defeat the validity of said waivers. That the following are the names of all parties who have furnished material or labor, or both for said work and all parties having contracts for specific portions of side work or for material entering into the construction thereof and the amount due or to become due to each, and that the items mentioned include all labor and material required to complete said work according to plans and specifications: NAMES WHAT FOR CONTRACTPRICEAMOUNTPAIDTHISPAYMENTBALANCEDUE _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ TOTAL LABOR AND MATERIAL TO COMPLETE_______________________________________That there are no other contracts for said work outstanding, and that there is nothing due or to become due to any person for material, labor or other work of any kind done or to be done upon or in connection with said work other than above stated.Signed this _____ day of _______________, ______. Signature: _________________________________________________ State of _________________County of_________________Signed and sworn (or affirmed) to before me on ________________ (date) by ______________________(name/s of person/s making statement). ___________________________________________________________________ Signature of Notary Public (SEAL)