Receipt and Waiver of Mechanic's Lien Rights

Date:

The undersigned hereby acknowledges receipt for the sum of $

as

PARTIAL PAYMENT

FULL AND FINAL PAYMENT

for (describe type of work, supplies or services rendered)

furnished to the following described real property (Iegaldrscription. street address or project name)

Owner

General Contractor (if applicable)

Contract Amount $

and for value received waives any and all lien rights to file a mechanic's lien against said real property for material, labor or service to said property.

Company Name

By:

Title:

Phone: