Fillable Printable Standard Lien Waiver Template
Fillable Printable Standard Lien Waiver Template
Standard Lien Waiver Template
F625-029-000 Release of lien form 04-2012
WAIVER OF LIEN BY CONTRACTOR, SUBCONTRACTOR(S) AND SUPPLIER
We, the undersigned, acknowledge receipt of the amounts stated below as full payment for all
labor, professional services, materials, or equipment furnished for use on or about the property of
__________________________________________ (owner) in ___________________________
County, Washington, through the __________ day of _______________ (month), 20__ (year).
The property is described as follows (give legal description):
Each person or entity signing this release form releases and waives any interest in the property
described above and releases and waives any right to claim a lien on that property for any labor,
professional services, materials, or equipment provided through the date listed above. Each person
or entity signing this release form reserves the right to claim a lien for any labor, professional
services, materials, or equipment provided after that date, to the extent allowed by law.
The consideration received by each person or entity for this release is as follows:
$
COMPANY NAME
AUTHORIZED SIGNATURE
AMOUNT RECEIVED
PRINTED NAME OF PERSON
SIGNING THIS RELEASE
TITLE DATE CONTRACTOR
SUBCONTRACTOR
SUPPLIER
$
COMPANY NAME
AUTHORIZED SIGNATURE
AMOUNT RECEIVED
PRINTED NAME OF PERSON
SIGNING THIS RELEASE
TITLE DATE CONTRACTOR
SUBCONTRACTOR
SUPPLIER
$
COMPANY NAME
AUTHORIZED SIGNATURE
AMOUNT RECEIVED
PRINTED NAME OF PERSON
SIGNING THIS RELEASE
TITLE DATE CONTRACTOR
SUBCONTRACTOR
SUPPLIER
$
COMPANY NAME
AUTHORIZED SIGNATURE
AMOUNT RECEIVED
PRINTED NAME OF PERSON
SIGNING THIS RELEASE
TITLE DATE CONTRACTOR
SUBCONTRACTOR
SUPPLIER
This Lien Release form is provided by Labor & Industries as required under RCW 60.04.250.
