UTAH UNCONDITIONAL WAIVER AND RELEASE UPON FINAL PAYMENT
Property Name:
Property Location:
Undersigned’s Customer:
Invoice/Payment Application Number:
Final Payment Amount: $
*Check Number(s):
The undersigned acknowledges that the undersigned has received payment in the Payment Amount
described above and that the undersigned has (1) endorsed a check in the above referenced Payment
Amount payable to the undersigned; and (2) the check has been paid by the depository institution on
which it was drawn, which constitutes payment in full for all labor, services, equipment or material
furnished by the undersigned to the Property or Job described above or to , the undersigned’s customer.
To the extent provided below, this document releases, and the undersigned hereby waives, any
mechanic’s lien right , stop payment right, state or federal statutory bond right, private bond right, claim
for payment , and is considered to waive any notice of lien or right under Utah Code Ann., Title 38,
Chapter 1a, Preconstruction and Construction Liens, or any bond right under Utah Code Ann., Title 14,
Contractors’ Bonds, or Section 63G-6a-1103 related to payment rights the undersigned has on the above
described Property or Job.
This waiver and release applies to the final payment for the work, materials, equipment, or a combination
of work, materials, and equipment furnished by the undersigned to the Property or to the Undersigned’s
Customer.
The undersigned warrants that the undersigned either has already paid or will use the money the
undersigned received from the final payment promptly to pay in full all the undersigned’s laborers,
subcontractors, materialmen, and suppliers for all work, materials, equipment, or combination of work,
materials, and equipment that are the subject of this waiver and release.
NOTICE: This document waives rights unconditionally and states that you have been paid for giving
up those rights. This document is enforceable against you if you sign it, even if you have not been
paid. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL RELEASE FORM.
Dated: ____________________
(Company Name)
By:
Signature
Printed Name
Its:
Title
E-mail to:
OR Fax to:
801-621-7329
OR Mail original to: P.O. Box 9195
Ogden, UT 84409