4F, Pay Application #6 from A.J. Spanjers

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FINAL WAIVER of LIEN To All Whom It May Concern: WHEREAS, the undersigned has been employed by (A) City of Arden. Hills .to furnish labor and materials for (S) Exterior Masonry Restoration work, under a contract ( C ) for the improvement of the premises described as () Arden Hills City Hail .j in the city _. (City -Village) of Arden Hills Courity.of Ramsey - - ...._.,., Mate of Minnesota of which City of Arden Hills is the owner. NOW, THEREFORE, this 12 day of August for and in consideration of the sum of (E) $ 1 �• 828- SS Dollars paid simultaneously herewith, the receipt whereof is hereb acknowledged b . . . Y g y the undersigned, the under- signed does hereby waive and release any lien rights to, or claim of lien with respect to and on said above - described premises, and the improvements thereon, and on the monies or ether considerations due or to become due from the owner, on account of labor, services, material, fixtures, apparatus or machinery heretofore or which may hereafter be furnished b the undersigned to or far - . Y g the above -described premises .by virtue of sold contract. (Affix corporate sea! here) INSTRUCTIONS FOR FINAL. WAIVER ( ) A. J . Span j Hers Co. , Inc. (SEAL) (Name of sole ownership, c rporartion or partnership) J' 1p r { FAl I i natUrei TITLE: President {A} Person or firm with whore you agreed to furnish either labor, or services, or materials, or both. (8) Fill in nature and extent of work; strike the word labor orthe worts materials it not irr your contract. [C) If you have more than one contract on the see premises, describe the contract by number if available, date and extent of work. M Furnish an accurate enough description of the improvement ant# location of the premises so that it can be distinguished from any other property, W Amount shown should be the amount actually received and equal to total amount of contract as adjusted. tF} If waiver Is for a corporation, corporate name should be used, corporate seal afted and title of officer signing waiver should be set forth; it waiver is for a partnership, the partnership name should be used, Partner Aould sign and designate himself as partner. Designed By The Construction Industry Affairs Committee (CJAQ TOPS 3458 LITHO IN U. S. A. CCOPYREGHT 1973. TOPS BUSINESS FORMS. CHICAGO. ILL.