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

WAIVER OF LIEN

SUB-CONTRACTOR'S PARTIAL

TO COVER ONLY CERTAIN PAYMENTS

STATE OF ILLINOIS

)

) SS

COUNTY OF PEORIA

)

TO WHOM IT MAY CONCERN:

THE undersigned, _______________________________________________________________________________

(sub-contractor)

has been employed by ___________________________________________________________________________________

(general contractor)

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, 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 4