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Conditional Receipt and Waiver of Mechanic's Lien Rights <br />Dated: _� k / I (e /,S <br />Upon receipt by the undersigned of a check from �a Cnj ()[C in the sum of <br />and when the check has been properly endorsed and liaJbecn paid by the <br />bank upon which it is drawn, this document shall become effective to release any mechanic's <br />lien, stop notice, or bond right the undersigned has as follows: <br />Check Only One <br />1) ❑ as partial payment for labor, skill and material furnished or to be furnished. <br />2) ❑ as payment for all labor, skill and material furnished or to be furnished (except the <br />sum of $ retainage or holdback) <br />3) Xas full and final payment for all labor, skill and material furnished or to be furnished <br />fo the following described real property: <br />Owner Name: ;I�RZ C1��1 nCa <br />Street Addressl: <br />Street Address2: <br />City: ' �y 1 I.S State: <br />MN Zip: -n ( I J, <br />And for value received hereby waives all rights acquired by the undersigned to file or record mechanic's <br />liens against said real property for labor, skill or material furnished to said real property (only for the <br />amount paid if Box 1 is checked, and except for retainage shown if Box 2 is checked), The undersigned <br />affirms that all material furnished by the undersigned has been paid for, and all subcontractors employed <br />by the undersigned have been paid in full. <br />(Note: if this instrument is executed by a Corporation, it must be signed by an officer and if <br />executed by a partnership, it must be signed by a partner.) <br />Company Name: Ncs�n _QJ <br />r <br />Signed By: <br />Title: <br />Street Address: ( <br />City: S]-, [?0AAJ State: MN Zip: ,Sjo <br />FOR SUB -CONTRACTORS <br />