Fillable Printable Multistate Lien Waiver Form
Fillable Printable Multistate Lien Waiver Form
Multistate Lien Waiver Form
MULTISTATE LIEN WAIVER –
Single-Family
– Fannie Mae HOMESTYLE MODEL DOCUMENT Form 3739 11/01
(page 1 of 2 pages)
LIEN WAIVER
THIS IS A MODEL DOCUMENT FOR USE IN CONSTRUCTION LOAN TRANSACTIONS.
THIS FORM IS PROVIDED AS AN EXAMPLE AND IS NOT VALID AND ENFORCEABLE
IN ALL JURISDICTIONS. LENDERS SHOULD CONSULT WITH LEGAL COUNSEL TO
ENSURE THAT ALL FORMS USED TO ORIGINATE LOANS ARE APPROPRIATE, AND
THAT ALL LEGAL INSTRUMENTS ARE COMPLETED CORRECTLY AND IN
COMPLIANCE WITH APPLICABLE LAW.
STATE OF
)
) ss.:
COUNTY OF
)
TO WHOM IT MAY CONCERN:
WHEREAS, the undersigned has been employed by
to furnish
for the premises known as
of which
is the owner.
The undersigned, for and in consideration of _________________________________________
($
) Dollars, and other good and valuable consideration, the receipt whereof is
hereby acknowledged, do(es) hereby waive and release any and all lien or claim of, or right to, lien,
under laws relating to mechanics’ liens, with respect to and on said above-described premises, and
the improvements thereon, and on the materials, fixtures, apparatus or machinery furnished, and on
the moneys, funds or other considerations due or to become due from the owner, on account of labor,
services, material, fixtures, apparatus or machinery furnished to this date by the undersigned for the
above-described premises.
Given under
hand and seal this
day of
,
.
Signature and Seal:
NOTE: All waivers must be for the full amount paid. If waiver is for a corporation, corporate
name should be used, corporate seal affixed and title of officer signing waiver should be set forth;
if waiver is for a partnership, the partnership name should be used, partner should sign and
designate him(her)self as partner.
CONTRACTOR’S AFFIDAVIT
STATE OF
)
) ss.:
COUNTY OF
)
TO WHOM IT MAY CONCERN:
The undersigned, being duly sworn, deposes and says that (s)he is
of the
MULTISTATE LIEN WAIVER –
Single-Family
– Fannie Mae HOMESTYLE MODEL DOCUMENT Form 3739 11/01
(page 2 of 2 pages)
who is the contractor for the
work on the building located at
owned by
That the total amount of the contract including extras is $
on which
(s)he has received payment of $
prior to this payment. That all waivers
are true, correct and genuine and delivered unconditionally and that there is no claim either legal or
equitable to defeat the validity of said waivers. That the following are the names of all parties who
have furnished material or labor, or both for said work and all parties having contracts or sub-
contracts for specific portions of said work or for material entering into the construction thereof and
the amount due or to become due to each, and that the items mentioned include all labor and material
required to complete said work according to plans and specifications:
NAMES PURPOSE
CONTRACT
PRICE
AMOUNT
PAID
THIS
PAYMENT
BALANCE
DUE
TOTAL LABOR AND MATERIALS TO
COMPLETE:
That there are no other contracts for said work outstanding, and that there is nothing due or to become
due to any person for material, labor or other work of any kind done or to be done upon or in connection
with said work other than above stated.
Signed this
day of
,
.
Signature:
Subscribed and sworn to before me this
day of
,
.
Signature:
