HomeMy WebLinkAboutUnconditional Waiver and Release of Lien Upon Final Payment - Ph. II i
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UNCONDITIONAL WAIVER AND RELEASE OF
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LIEN UPON FINAL PAYMENT
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1 The undersigned lienor, in consideration of the final payment in the amount of $ 0.00
I hereby waives and release its lien and right to claim a lien for labor, services or materials to
(customer) Brewer Paving on the job of City of Cape Canaveral (Owner) to the following
described property:
Ridgewood Avenue Phase II
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Dated Pir < 1 a$ , 2011
1 Lienor's Name Whiteleaf Inc DBA Gene's Striping
Address 3001 Industrial Ave Thre
Fort Pierce, FL 34946
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By lrt/
Printed Name s t�i,vpd (,Wx& r
Title Prei cle.v't
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Personally appeared before me this Z � day of ' ( , 2011
by >QAnd A.2 (' who, being duly sworn on oath, says that
he /she is Petde-vA" of Gene's Striping who is personally known to me
or has produced identification.
1 Q Personally known to me
❑ Produced identification
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t 0%0 FLLY LYNN FARNHAM
. . : 4. EX PIRC: .erc,'.1 2014
1 Notary Stamp ,x ; .0 Notary Signature
(407) 398 -0153 FioridallotaryService.com
Note: This is a statutory form prescribed by Section 713.20, Florida Statutes (1996) Effective October 1, 1996,
a person may not require a lienor to furnish a waiver or release of lien that is different from the statutory form.
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