Georgia Lien Waiver Form

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

NOTICE OF LIEN WAIVER

NOTICE IS HEREBY GIVEN that the undersigned has been employed by {{contractor_name}}, hereinafter referred to as the "Contractor", to furnish labor, materials, or services for the improvement of the property located at {{property_address}}, owned by {{owner_name}}, hereinafter referred to as the "Owner".

WAIVER OF LIEN

Upon receipt of the sum of {{payment_amount_words}} ({{payment_amount_currency_symbol}}{{payment_amount_numbers}}), the undersigned waives and releases any and all liens or claims of lien, stop notices, payment bond rights, or other rights to recover for labor, services, equipment, or materials furnished to the above-described property, up to and including the date of this waiver, for the payment received.

This waiver and release does not cover any retention or items furnished after the date of this waiver unless specifically stated herein.

AFFIDAVIT

The undersigned hereby certifies that he/she has been paid in full for all labor, materials, and services furnished for the improvement of the above-described property, up to and including the date of this waiver, and that there are no outstanding debts or obligations related to such labor, materials, or services for which a lien could be claimed.

The undersigned further certifies that it has the authority to execute this waiver and release on behalf of {{entity_name}}.

CONSIDERATION

The undersigned acknowledges that this lien waiver is given in consideration of the payment received and that the Owner or Contractor has relied on this waiver in making such payment.

PROJECT INFORMATION

Project Name: {{project_name}}

Job Number: {{job_number}}

Invoice Number: {{invoice_number}}

SIGNATURE BLOCK

IN WITNESS WHEREOF, the undersigned has executed this Lien Waiver Form on the date set forth below.

_________________________________________

Signature

Printed Name: {{signatory_name}}

Title: {{signatory_title}}

Company Name: {{signatory_company_name}}

Date: {{current_date}}

SWORN TO AND SUBSCRIBED before me this {{day_of_month}} day of {{month}}, {{year}}.

_________________________________________

Notary Public

My Commission Expires: {{notary_commission_expiry}}