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WAIVER AND RELEASE OF LIEN UPON FINAL PAYMENT <br />The undersigned lienor, in consideration of the final payment in the amount of <br />$ ro. I. , hereby waives and releases its lien for labor, services or <br />materials furnished to (customer) Ag-Scape Services on the job of <br />(owner) IZ, v u C- rk y" , to the following described <br />property: <br />Sl -01- <br />Dated <br />O1. <br />Dated 201.E <br />=.' DEBORAH A CROCKETT <br />MY COMMISSION # EE209641 <br />EXPIRES June 19, 2016 <br />{ ,nr:79W53 .tom <br />Lienors Name <br />Addressi-ldx;'x �l'my z6W dcc;�C'k <br />j v v �^ ' <br />Printed name x <br />�i <br />Personally appeared before me this /bj l�- day of -FA ,2016that he/she is <br />U who, being duly sworn on oath, says thsat he/she is <br />� e0 b) 5 of Jc _ � (;Jr � � �:y� �Vl a S G�'lu ►-�c� who is <br />personally know to me who has produced as <br />identification. <br />4Jl Ii <br />11 L11I� " <br />Notary Signature <br />Notary Stamp <br />Note: This is a statutory form prescribed by Section 713.20, Florida Statues (1996) <br />Effective October 1, 1996, a person may not require a lienor to furnish a waiver or <br />release of lien that is different from the statutory form. <br />32 <br />