Copyright ©2005 Greater Illinois Title Company. All Rights Reserved. http://gitc.com/forms/
Compliments of Greater Illinois Title Company; for Internal and External Use.
Unive
rsal Doc Ref: GP_IEF0029-20050804-R1-0
FINAL WAIVER OF LIEN
STATE OF ILLINOIS
Gty # ___
__________________
COU
NTY OF _____________________________
}
SS
Escrow # ______
_______________
TO WHOM IT MAY CONCERN:
WHEREAS the undersigned has been emplo
yed by ____________________________________________________________________
to furnish _______________________________________________________________
______________________________________
for the premises
known as ________________________________________________________________________________________
of which _______________________________________________________________
____________________________ is the owner.
THE undersigned, for and in consideration of _______________________________________________________________
__
($__________________________) Dollars, and other good and valuable considerations, the receipt whereof is hereby acknowledged,
do(es) hereby waive and release any and a
ll lien or claim of, or right to, 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 material, fixtu
res,
apparatus or machinery furnished, and on the moneys, funds or other considerations due or to become due from the owner, on account of
a
ll l
abor, services, material, fixtures, apparatus or machinery, heretofore furnished, or which may be furnished at any time hereafter, by
the undersigned for the above-describe
d premises, INCLUDING EXTRAS.*
DATE ____________________________ COMPANY NAME ________________________________________________________
ADDRESS ________________________________________________________________
SIGNATURE AND TITLE _______________________________________________________________
* EXTRAS INLCUDE BUT ARE NOT LIMITED TO CHANGE ORDERS, BOTH ORAL AND WRITTEN, TO THE CONTRACT.
-------------------------------------------------------------------------------------------------------------------------------------------------------------------
STATE OF ILLINOIS
COU
NTY OF _____________________________
}
SS
CONTRACTOR’S AFFIDAVIT
TO WHOM IT MAY CONCERN:
THE UNDERSIGNED, (NAME) ____________________________________________ B
EING DULY SWORN, DEPOSES
AND SAYS THAT HE OR SHE IS (POSITION) _______________________________________________________________
___ OF
(COMPANY NAME) _______________________________________________________________
________________ WHO IS THE
CONTRACTOR FURNISHING __________________________________________________________ WORK ON THE BUILDING
LOCATED AT _______________________________________________________________
_________________________________
OWNED BY _______________________________________________________________
___________________________________
That the total amount of the contract including extras* is $______________________________ on which he or she has received
payment of $ __________________________ prior to this payment. That all waivers are true, correct and genuine and delivered
u
nconditionally a
nd that there is no claim either legal or equitable to defeat the validity of said waivers. That the following are the names
and addresses of all parties who have furnished material or labor, or both, for said work and all parties having contracts or su
b contracts
for specific portions of said work or for material entering into the construction thereof and the amount due or to become due to e
ach, and
that the items mentioned include all labor and material required to complete said work according to plans and specifications:
NAMES AND ADDRESSES WHAT FOR
CONTRACT PRICE
INCLDG EXT
RAS*
AMOUNT
PAID
THIS
PAYMENT
BALANCE
DUE
TOTAL LABOR AND MATERIAL INCLUDING EXTRAS* TO COMPLETE
That there are no other contacts for said work outstanding, and that there is nothing due or to become due to any person for material,
labor o
r other work of any kind done or to be done upon or in connection with said work other than above stated.
DATE ___________________________ SIGNATURE _______________________________________________________
SUBSCRIBED AND SWORN TO BEFORE ME THIS _______________ DAY OF ___________________________,________,
*EXTRAS INCLUDE BUT ARE NOT LIMITED TO CHANGE
ORDERS, BOTH ORAL AND WRITTEN, TO THE CONTRACT.
_
_______________________________________________
NOTARY PUBLIC
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