Notice Of Commencement Form - State Of Florida, County Of Miami-Dade (Page 3 of 4) in pdf

RELEASE OF LIEN AND AFFIDAVIT

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1. The undersigned contractor, for an in consideration of the payments of the sum of _______________paid by receipt of which

is hereby acknowledged, hereby releases and quit claims to_________________________________, the owner of the hereinafter

described property, all liens, lien rights, claims or demands of any kind whatsoever, which the undersigned now has to might

have against the building located on, or premises legally described as ________________________________________________

_______________________________________________________________________________________________________________

on account of labor performed and/or materials furnished for the construction of any such improvements on said premises.

2. All labor and materials used by the undersigned in the erection of said improvements have been paid in full, except as

f ollows: _ _______________________________________________________________________________________________________

_______________________________________________________________________________________________________________

3. All lienors furnishing labor, services, or materials for said improvements have been paid in full, except as follows:

_______________________________________________________________________________________________________________

4. This instrument is executed and delivered to the owner in compliance with Chapter 713, Florida Statutes.

5. The undersigned contractors does hereby consent to the payment by the owner of all lienors giving notice and those lienors

above named.

IN WITNESS WHEREOF, I have hereunto set by hand and seal this ______________ day of ___________________, 20_______

Witnesses:

1. ________________________________________________

_____________________________________________ (SEAL)

(Contractor)

2. ________________________________________________

By ________________________________________________

(President)

STATE OF FLORIDA:

COUNTY OF MIAMI-DADE:

I, hereby acknowledge that the statements contained in the foregoing Release of Lien and Affidavit are true and correct. Sworn

to and subscribed before me, this _______________ day of ______________________, 20______.

Notary Public ___________________________________

Print Notary’s Name: _____________________________

My Commission Expires: _________________________

123.01-52 PAGE 5 3/10

Notice Of Commencement Form - State Of Florida, County Of Miami-Dade Page 3