Mechanic's Lien Waiver

Mechanic’s Lien Waiver

Type of Waiver? PartialUnconditional

Client's Name?

Client's Email Address?

Is the waiving party a business REGISTERED with a secretary of state? YesNo

Registered with which STATE?

Waiving Party's NAME?

What TYPE of Business?

Waiving Party's ADDRESS?

Who is signing the affidavit for the waiving party?

Waiving Party's NAME?

If not a registered business, is waiving party doing business under a FICTITIOUS NAME? YesNo

What is the FICTITIOUS NAME?

Waiving Party's ADDRESS?

PARTIAL: Waiving through what date?

Amount RECEIVED to date? $

Amount TO BE PAID? $

NAME of contracting party?

Contracting Party's ADDRESS?

Are there any UNPAID CLAIMS? YesNo

If there is more than one unpaid claim, provide each additional claimant's name, address, and amount owed in the "Additional Comments" section below

CLAIMANT: What is the claimant's NAME?

CLAIMANT: Claimant's ADDRESS?

CLAIMANT: Amount TO BE PAID to claimant? $

STATE where work performed?

COUNTY where work performed?

Property Address?

Permanent Parcel Number?

Additional Comments