Massachusetts's lien waiver law.

COMMONWEALTH OF MASSACHUSETTS: Date: _____________ __________ COUNTY Application for Payment No: ____________ OWNER: _______________________________ CONTRACTOR: _________________________ LENDER/MORTGAGEE: ________________ 1. Original Contract Amount: _________ 2. Approved Change Orders: _________ 3. Adjusted Contract Amount: _________ (line 1 plus 2) 4. Completed to Date: _________ 5. Less Retainage: _________ 6. Total Payable to Date: _________ (line 4 less line 5) 7. Less Previous Payments: _________ 8. Current Amount Due: _________ (line 6 less line 7) 9. Pending Change Orders: _________ 10. Disputed Claims: _________ The undersigned who has a contract with ___ for furnishing labor or materials or both labor and materials or rental equipment, appliances or tools for the erection, alteration, repair or removal of a building or structure or other improvement of real property known and identified as ___ located in ___ (city or town), ___ County, Commonwealth of Massachusetts and owned by ___, upon receipt of ___ ($___) in payment of an invoice/requisition/application for payment dated ___ does hereby: (a) waive any and all liens and right of lien on such real property for labor or materials, or both labor and materials, or rental equipment, appliances or tools, performed or furnished through the following date: ___ (payment period), except for retainage, unpaid agreed or pending change orders, and disputed claims as stated above; and (b) subordinate any and all liens and right of lien to secure payment for such unpaid, agreed or pending change orders and disputed claims, and such further labor or materials, or both labor and materials, or rental equipment, appliances or tools, except for retainage, performed or furnished at any time through the twenty-fifth day after the end of the above payment period, to the extent of the amount actually advanced by the above lender/mortgagee through such twenty-fifth day. Signed under the penalties of perjury this ___ day of ___, ___.