New York Lien Waiver Form

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Lien Waiver Form

Date: {{date}}

Project Name: {{project_name}}

Project Location: {{project_location}}

Waiver and Release of Lien (New York)

WHEREAS, the undersigned {{Waiver_Company_Name}} (hereinafter 'Waiver Company') has been employed by {{property_owner_name}} (hereinafter 'Owner') to furnish {{labor_materials_services}} for the improvement of real property commonly known as {{property_address}} (hereinafter 'Property');

NOW, THEREFORE, the undersigned, for and in consideration of the sum of {{amount_received}} (${{amount_number}}) and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, does hereby waive and release any and all liens, claims, and rights to file a lien which the undersigned has or may have on the Property for labor, services, equipment, or materials furnished up to and including the date of this Waiver and Release of Lien.

Type of Waiver

Choose one:

☐ Conditional Waiver and Release Upon Progress Payment – This is a conditional waiver and release of lien upon a progress payment. This document is effective only if the Waivers Company receives the payment described below.

☐ Unconditional Waiver and Release Upon Progress Payment – This is an unconditional waiver and release of lien upon a progress payment. By signing this document, the Waivers Company declares that they have received the payment described below, and they waive and release all lien rights for the period covered by this payment.

☐ Conditional Waiver and Release Upon Final Payment – This is a conditional waiver and release of lien upon final payment. This document is effective only if the Waivers Company receives the final payment described below.

☐ Unconditional Waiver and Release Upon Final Payment – This is an unconditional waiver and release of lien upon final payment. By signing this document, the Waivers Company declares that they have received the final payment described below, and they waive and release all lien rights for the entire project.

Payment Information

Amount of Payment: ${{amount_number}}

Check Number (if applicable): {{check_number}}

Payment Period Covered: From {{start_date}} to {{end_date}}

Acknowledgement

The undersigned acknowledges that this Waiver and Release of Lien is given voluntarily and without duress, and that the undersigned has read and understands the terms hereof.

This Waiver and Release of Lien is subject to all applicable provisions of the New York Lien Law.

Signature Block

_____________________________

Signature of Waiver Company Representative

Printed Name: {{representative_name}}

Title: {{representative_title}}

Company Name: {{Waiver_Company_Name}}

Date: {{signature_date}}

Notary Public (Optional)

State of New York

County of {{county}}

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

_____________________________

Notary Public Signature

Printed Name: {{notary_name}}

My Commission Expires: {{commission_expiration_date}}