Statute · MCL 570.1115(9)(a)
Fill in and sign this formPARTIAL UNCONDITIONAL WAIVER
(a) PARTIAL UNCONDITIONAL WAIVER
I/we have a contract with ________ to
(other contracting party)
provide ________ for the improvement to the property described as ________ , and by signing this waiver waive my/our construction lien to the amount of $________ , for labor/materials provided through ________ .
(date)
This waiver, together with all previous waivers, if any, (circle one) does does not cover all amounts due to me/us for contract improvement provided through the date shown above. If the improvement is provided to property that is a residential structure and if the owner or lessee of the property or the owner's or lessee's designee has received a notice of furnishing from me/one of us or if I/we are not required to provide one, and the owner, lessee, or designee has not received this waiver directly from me/one of us, the owner, lessee, or designee may not rely upon it without contacting me/one of us, either in writing, by telephone, or personally, to verify that it is authentic.
________
________
(signature of lien claimant)
Signed on: ________
Address:________
(date)
________
Telephone:________
DO NOT SIGN BLANK OR INCOMPLETE FORMS. RETAIN A COPY.