CONDITIONAL WAIVER AND RELEASE OF LIEN UPON FINAL

CONDITIONAL WAIVER AND RELEASE OF LIEN

UPON FINAL PAYMENT

(State of Colorado)

Upon receipt by the undersigned of a check in the sum of $____________________, payable to the

undersigned, and when the check has been properly endorsed and has been paid by the bank on which it is

drawn, this waiver and release document shall become effective and enforceable.

Subject to the above language, the undersigned lienor, in consideration of the final payment of

$__________, hereby waives and releases its lien and right to claim a lien for labor, services, or materials

furnished to

(insert the name of your customer) on the job of

(insert the name of the owner) to the following

property:

______________________________________________________________________

(description of property)

______________________________________________________________________

All debts owed to any third party by the person waiving the lien rights and relating to the goods or

services covered by the above waiver of lien rights have been paid or will be timely paid.

DATED on _______________, 20_____ _________________________________________

(Claimant name)

By: ___________________________________

Its: ___________________________________

Address:____________________________

___________________________________

Phone: ____________________________

Fax: _______________________________