Georgia Lien Waiver Form

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

NOTICE OF LIEN WAIVER

Date: {{date}}

To: {{property_owner_name}}

From: {{lien_claimant_name}}

Project Name: {{project_name}}

Job Location: {{job_location}}

PARTIAL WAIVER OF LIEN

The undersigned Lien Claimant, in consideration of the payment of {{partial_payment_amount}} USD, does hereby waive and release any and all liens or claims of liens, stop notices (if applicable), and payment bond rights, whether statutory or contractual, that the undersigned has on the above-described project and job location to the extent of the payment received. This waiver covers the labor, services, equipment, or materials furnished through {{through_date}}.

FULL WAIVER OF LIEN (UPON FINAL PAYMENT)

The undersigned Lien Claimant, in consideration of the final payment of {{final_payment_amount}} USD, does hereby waive and release any and all liens or claims of liens, stop notices (if applicable), and payment bond rights, whether statutory or contractual, that the undersigned has on the above-described project and job location. This waiver covers all labor, services, equipment, or materials furnished to the project, including all retainage due the undersigned. The undersigned acknowledges receipt of said payment and declares that no further payments are due or shall become due from {{property_owner_name}} to the undersigned on account of labor, services, equipment, or materials furnished to the project.

AFFIDAVIT

The undersigned, being duly sworn, deposes and says that he/she is {{title}} of {{lien_claimant_company_name}}, and has the authority to execute this waiver on its behalf, and that all labor and materials for which this waiver is executed have been paid for or will be paid for in full from the proceeds of this payment.

GOVERNING LAW

This Lien Waiver shall be governed by and construed in accordance with the laws of the State of Georgia.

Signature Block

______________________________

Printed Name: {{lien_claimant_name}}

Title: {{title}}

Company: {{lien_claimant_company_name}}

Date: {{signature_date}}

State of Georgia

County of {{county}}

Sworn to and subscribed before me this {{day}} day of {{month}}, {{year}}.

______________________________

Notary Public

My Commission Expires: {{commission_expiration_date}}