Final Waiver Of Lien - Illinois (Page 2 of 4) in pdf

WAIVER OF LIEN

GENERAL CONTRACTOR'S PARTIAL

TO COVER ONLY CERTAIN PAYMENTS

STATE OF ILLINOIS

)

) SS

COUNTY OF PEORIA )

TO ALL WHOM IT MAY CONCERN:

WHEREAS, the undersigned ________________________________________________________ has been employed

by THE PEORIA PARK DISTRICT to furnish material and labor for the __________________________________________at

the premises commonly known as __________________________________________________________________________

______________________________________________________________________________________________________

located in the City of Peoria, County of Peoria, and State of Illinois.

NOW, THEREFORE, the undersigned, for and in consideration of the sum of _________________________________

_____________________________________________________ Dollars, and other good and valuable considerations, the receipt

whereof is hereby acknowledged by the undersigned, does hereby waive and release to the extent only of the aforesaid amount of

___________________________________________ Dollars, paid simultaneously herewith, any and all lien or right or claim of

lien under the statutes of the State of Illinois relating to mechanics' liens, with respect to and on said above-described premises,

and the improvements thereon and on the money, funds, or other consideration due or to become due from the owner on account

of labor, services, material, fixtures, apparatus or machinery, furnished by the undersigned, to or on account of the said owner, for

the above-described premises, but only to the extent of the payment aforesaid.

Dated this ______________ day of ________________________________________, 20 _______.

[Affix corporate seal here]

_________________________________________

(Name of sole owner, corporation or partnership)

ATTEST:

__________________________________________ ___________________________________(SEAL)

(Signature of secretary of corporation)

(Signature of sole owner or authorized

representative of corporation or partnership)

________________________________________________________________________________________________________________________________

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Final Waiver Of Lien - Illinois Page 2