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WAIVER AND RELEASE OF LIEN AGREEMENT

Recording Requester:

Mail to:

City, State, Zip:

Company Name ("Grantor") is releasing First Last ("Grantee") from all known liens or claims of liens relating to the labor or materials described below which have been provided to Grantee up to the date on this Agreement.

I, the undersigned, residing at Insert Contract Address, do hereby consent to release First Last from all known liens or claims of liens for the following:

Insert the scope of the release of lien - including line items for all labor, materials, products, services, dates, invoices, job numbers, legal or recorded documents or any other relevant information. I further attest that I have not assigned any of my rights concerning any claims or obligations covered under this Agreement to any third party or individual, and I do hereby swear that the above-listed labor and/or materials have been paid in full. I further agree that this release shall bind me and my successors. In witness whereof, the parties have executed this Agreement this Current Day day of Current Month, Current Year.

Job title of signator, authorized signature or signer. Job title of signator, authorized signature or signer.

Date of Agreement: