New York Lien Waiver Form

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

DATE

{{date}}

TO WHOM IT MAY CONCERN:

{{lien_recipient_name}}

{{lien_recipient_address}}

PROJECT INFORMATION

Project Name: {{project_name}}

Project Location: {{project_address}}

Owner: {{owner_name}}

Contractor: {{contractor_name}}

WAIVER OF LIEN

WHEREAS, the undersigned, {{lienor_name}} (hereinafter “Lienor”), has furnished {{labor_materials_services}} to the above-referenced project; and

WHEREAS, the Lienor has been paid or will be paid the sum of {{payment_amount}} Dollars (${{payment_amount_numeric}}) for said {{labor_materials_services}} furnished to the project through {{payment_through_date}}.

ACKNOWLEDGMENT AND RELEASE

NOW, THEREFORE, in consideration of the payment received, the Lienor does hereby waive and release any and all liens, lien rights, claims or demands against the owner(s) of the property, the property itself, and any sureties on any bonds issued in connection with the project, for labor, services, equipment or materials furnished to the project through {{payment_through_date}}.

AFFIDAVIT

The Lienor further certifies that all subcontractors, materialmen, and laborers employed by the Lienor in connection with the project have been fully paid or will be paid from the funds received hereunder, for all work, labor, and materials furnished through {{payment_through_date}}. The Lienor agrees to indemnify and hold harmless the owner and contractor from any and all claims, liens, and suits that may arise due to non-payment of said subcontractors, materialmen, and laborers.

GOVERNING LAW

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

Signature Block

IN WITNESS WHEREOF, the undersigned has executed this Waiver of Lien on the date first written above.

_____________________________

{{lienor_signature}}

Printed Name: {{lienor_printed_name}}

Title: {{lienor_title}}

Company: {{lienor_company}}

STATE OF NEW YORK )

) ss:

COUNTY OF {{county}} )

On the {{day}} day of {{month}}, {{year}}, before me, the undersigned, a Notary Public in and for said State, personally appeared {{lienor_printed_name}}, personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her capacity, and that by his/her signature on the instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument.

_____________________________

Notary Public

My Commission Expires: {{notary_commission_expiry}}