Form for Waiver of Lien : Please fill out the following form. Please print your completed form if you would to have a copy for your records.
KNOW ALL BY THESE PRESENTS : That (NAME OF THE PERSON WHO IS RELEASING THE CLAIM TO THE LIEN) for and in consideration of $120,000 Dollars ($120,000 ) and other good and valuable consideration, to be paid, the receipt whereof is hereby acknowledged, do hereby waive, release, remise and relinquish any and all right to claim any lien or liens for work done or material furnished, or any kind of class of lien whatsoever on the following described property :
(address of the property)
Title owner of said property :
Signed, sealed and dated this day of (date with year) at (address of the property) :
Signed in the presence of :
STATE OF :
COUNTY OF :
On _______________________ before me _________________________ personally appeared ___________________________ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS my hand and official seal.
Affiant : Known / Unknown :
ID Produced :
Letters Used in Real Estate Index
Form for Waiver of Lien
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