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12-11-23-R
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12-11-23-R
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Dated: <br />From: <br />Box 1 <br />Box 2 <br />Box 3 X <br />22-038 <br />By: <br />Title: <br />RECEIPT AND WAIVER OF MECHANIC'S LIEN AND BOND RIGHTS <br />WAYZATA, MN 55391 <br />15422 LEONA LANE <br />HERNESS CONSTRUCTION CO. <br />CHECK ONLY ONE BOX OR BOX 1 WILL APPLY: <br />To the following real property: <br />INVOICE or PAY APPLICATION: <br />ARDEN HILLS <br />as payment for all labor, skill, and material furnished or to be furnished (except <br />the sum of $ as retainage or holdback) <br />as full and final payment for all labor, skill and material furnished or to be <br />furnished <br />as partial payment for labor, skill and material furnished <br />PROJECT NAME: <br />ADDRESS: <br />PROJECT ADDRESS: <br />ARDEN HILLS - SNELLING AVE <br />For value received the undersigned waives all rights acquired by the undersigned to record a <br />mechanic's lien against said real property or to make any claim against any bond for labor, skill <br />or material furnished to said property (only for the amount paid if Box 1 is checked, and except <br />for retainage shown if Box 2 is checked). The undersigned affirms that all material furnished by <br />the undersigned has been paid for, and all subcontractors retained by the undersigned have <br />been paid in full, EXCEPT: <br />CONTRACTOR: <br />$180.00 <br />October 16, 2023 <br />T.A. Schifsky & Sons, Inc. <br />The undersigned hereby acknowledges receipt of the sum of <br />Pay Estimate #5-FINAL <br />President <br />Amy Alvero
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