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RECEIPT AND WAIVER OF MECHANIC'S LIEN RIGHT <br />1. This is a LEGAL INSTRUMENT and must be executed accordingly by officers of corporations and <br />by partners in co -partnerships. <br />2. It is important that ALL the blanks be completed, and the AMOUNT PAID BE SHOWN. <br />3. A receipt similar to this or legal waiver of lien rights will be required for all plumbing, heating, <br />plastering materials, ect. <br />4. NO ERASURES OR ALTERATIONS MUST BE MADE <br />1) <br />2) As partial payment for labor, skill, and material furnished or to be furnished. <br />3) _As payment for all labor, skill, and material furnished or to be furnished. <br />(Except the sum $ retention) <br />4) X As full payment for all labor, skill, and material furnished or to be furnished to the <br />following described real property: (legal description, street address, or project name <br />2021 PMP Street & Utility Improvements <br />Arden Hills MN <br />And for the value received herby waives all rights acquired by the undersigned to file or record <br />mechanic's liens against said real property for labor, skill or material furnished to said real Document 1 <br />property (only for the amount paid in box 1 is checked, and except for retain age shown in Box 2 is <br />checked) The undersigned affirms that all material furnished by the undersigned has been paid for, and <br />all subcontractors employed by the undersigned have been paid in full. <br />Company: Ray Jordan & Sons, Inc. <br />Date:_ d t ]O o - /,�. .x- <br />Officer/Owner Signature J <br />PRINT NAME: <br />