Statute · W.S. § 29-10-101(b)
LIEN WAIVER
Note to lien claimant: Signing this form has legal
implications. If you have any questions regarding how to
complete this form or whether it has been properly completed,
you should consult an attorney.
LIEN WAIVER
TO:_____________________ PROJECT:_____________________
FROM:________________________
DATE:________________________
PAYMENT: $____________________
In consideration of the PAYMENT received to date, the
undersigned does hereby waive, release, and relinquish any and
all claim and/or right of lien against the project and the real
property improvements thereto for labor and/or materials
furnished for use in construction of the project; provided
however, the undersigned reserves all claims and/or rights of
lien as to monies withheld as retainage in the amount of
$_______________, and any labor and/or materials hereafter
furnished for which payment has not yet been made. The
undersigned has not been paid the sum of $________________ for
work performed and/or materials provided under contract on this
project and retains the right to file a lien against the
property and pursue any and all actions to recover the full
amount due, including any and all equitable claims. The
undersigned acknowledges receipt of payment for work performed
or materials provided and acknowledges that this waiver may be
relied upon by the owner even if the undersigned accepts payment
in uncertified funds and such payment is subsequently dishonored
or revoked, in which case this lien waiver shall remain in full
force and effect. The foregoing waiver shall not apply,
however, if payment tendered by the owner is dishonored or
revoked.
By:__________________________________
subcontractor/materialman/employee
Title:_______________________________
Date:________________________________
STATE OF __________________ )
)ss.
COUNTY OF ________________ )
This instrument was acknowledged before me on this _____
day of _____________, 20___, by _____________________ (name of
person) as lien claimant or ______________________ (title,
position or type of authority granted by lien claimant) of
_____________________________ (lien claimant).
IN WITNESS THEREOF, I have hereunto set my hand and affixed
my official seal on the day and year last above written.
______________________________
Notarial officer
My Commission Expires:
Seal: