This Instrument Prepared By:
Name ___________________________________
Address ___________________________________



WAIVER AND RELEASE OF LIEN
UPON FINAL PAYMENT


The undersigned lienor, in consideration of the final payment in the amount of $ _______________, hereby waives and releases its 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 the following described property:


DATED on ____________________, 20 ____.


Lienor's Name _________________________
Address _________________________


By _________________________
Printed Name _________________________


NOTE: This Waiver and Release of Lien may be conditioned upon clearance of the check tendered in payment of the amount stated therein by adding the following or similar language: "This release is conditioned upon clearance of the check tendered by ____________________ in payment of the amount stated herein. If collected funds are not received by lienor upon deposit of the check tendered, this Waiver and Release is null and void."
NOTE ALSO: Notary and/or witnesses may be added to this statutory form, if desired.