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SUPPLIER <br />WAIVER OF LIEN <br />STATE OF: �L j <br />COUNTY OF: 01� f eko e-� <br />TO WHOM IT MAY CONCERN: <br />Whereas the undersigned has bee �j employed by r � a 9V /C 0se- n iC, nl r ; (,� <br />to furnish 644or f M4-��At� I <br />for the premises known asjl. <br />of which: <br />is the owner. <br />The undersigned, for and in consideration of 6 guy 4kl oaysA+� <br />($ �A j 7Q , Ob ) Dollars, and other good and valuable considerations, the receipt whereof is hereby <br />acknow�edgpd, do hereby waive and release any and all lien or claim of, or right to, lien, under the statutes of the <br />State of/ , relating to Mechanic's liens, on the above described premises, and the improvements thereon, <br />and on the material, fixtures, apparatus or machinery furnished, and on the monies, funds or other considerations <br />due or to become 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: '� L <br />This Lien Waiver is considered a partial payment for the above mentioned project: <br />06 <br />Job # Check # Name of Company <br />Date <br />Signature & Title <br />Notary Seal SUBSCRIBED AND SWORN TO BEFORE ME THISy j day of (I t 20T <br />Notary <br />FU. <br />2.MY oM t SHORTER Commission Exp. I d, �a <br />M)$SION # FFS70849 <br />ao oaosa3 EXPIRES APM 01, 2020 <br />F7a'ida t�lery8 t rrke, can <br />51 <br />