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SUPPLIER <br />WAIVER OF LIEN <br />STATE OF: <br />COUNTY OF: <br />TO WHOM IT MAY CONCERN: <br />Whereas the undersiged has been employed by o,arr &nS4l1.cA1gn LL -Q <br />to furnish _ M jQ Ta"'; . ( S <br />for the premises own as <br />Of which: 4XAA <br />is the owner. <br />Fh <br />//,.,,� p;� <br />The undersigned, for and in consideration of tt1+ � r1 y �H i,.. .1�o,.tp„ � <br />four- a <br />($ 33r rf $0 . N2 ) Dollars, and other good and valuable considerations, the receipt whereof is hereby <br />acknowledged, do hereby waive and release any and all lien or claim of, or right to, Nen, under the statutes of the <br />State of relating to Mechanic's Ilene, on the above described premises, and the Improvements thereon, <br />and on the matedel. fixtures, apparatus or machinery furnished, and on the monies, funds or other considerations <br />due or to became due from the owner, on account of labor services, material, fixtures, apparatus or machinery, <br />furnished at anytime hereafter, by the undersigned for the above described premises. <br />Please Check one: <br />This Lien Waiver Is considered full payment for the above mentioned project: F' N 4L - <br />This Lien Waiver Is considered a partial payment for the above mentioned project., <br />Job # Check # Name of Company <br />Dateit'd. OYA]v1$ <br />Signature ✓� Tike <br />Notary\eat SUBSCRIBEDAN WORN TO BEFORE ME THIS day of , 20_ <br />Notary <br />Commission Exp. <br />104 <br />