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<br />'I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />0420 <br /> <br />Form No. 120-M (1031) <br /> <br />Mill.r.03"~ Co.. M_us UG-;1.8 <br />M'Mo,o!, UnUorm Con...V8J\cn; BI."1<S;19~ <br /> <br />RECEIPT AND \VAIVER OF MECH..\.:."HC'S LIEN RIGHTS <br /> <br />Dated: <br /> <br />1Q <br />~..."'- <br /> <br />The undersigned hereby acknowledges receipt of the sum of S <br /> <br />CHECK O!\LY ONE <br />~i 0 <br /> <br />:21 D <br /> <br />3) D <br /> <br />as paniaj payment for jaDo!". SKm and materia! furnished <br /> <br />as payment for all labor. skill and material furnished or to be furnished texcept the sum of <br />::: retainage or noldbackl <br /> <br />as full and final payment for aU labor. skill and material furnished or to be furnished <br /> <br />to the following ciescribed real property: (legal d~scriprion. street address 0: projeCt name) <br /> <br />and for vaiue received hereby waives a11 rights acquired by the undersigned to file or record mechanks liens <br />against said real property for labor. skill or material furnished to said real property (only for the amount paid if <br />Box 1 is checked, and except for retainage shown if Box 2 is checked). The undersigned affirms that all material <br />furnished by the undersigned has been paid for. and all subcontractors em,played by the undersigned have been <br />paid in full, EXCEPT: <br /> <br />By <br /> <br />NOTE: If this instrument is executed by a cor. <br />poration. it must be signed by an of. <br />ficer, and if executed by a partnership. <br />it must be signed by a partner. <br /> <br />1!ltle: <br /> <br />IAoer.Sf' <br />