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. 6A i•. <br />�if7lr� 1 ) I:?•11J Pine Wool • P.O. <br />box Silt,,f r-i ^t(1 �`,a' `1�� ' 1 �'' r%l1� Becker, WIN 55306 05•91' <br />Mice 763.M-0-1,iJ <br />SEWER WATER & EXCAVATION Fax 763-262.4.1+, <br />R-F.CE,JVr,-1jND WAIVER OF MECHANIC'S UEN RIGHTS <br />Dated,. , —L(_) ' _ Ld — C' — <br />-flee undersigned hereby acknowledges receipt of the sum of $ <br />CHEICK ONLY ONE, <br />LAUD -791 <br />t) as l)arcial payment for labor, skill and material furnished <br />2) �' as payment for all labor, skill and material furnished or to be furnished (excep# fire Burn of <br />_,retainage or holdback) <br />3) 0 as full and final payment for all labor, skill and material furnished or to be furnished <br />to the following described real property; (legal description, street address or project name) <br />C��r'e f' S � CI c:�� � •� ��Ci C� <br />and for value received hereby waives all rights acquired by the undersigned to file or record mechanic's liens against <br />said real property for tabor, skill or material furnished to said real property (only for the amount paid if Box i is checked, <br />and except for retainage shown if Box 2 is checked). The undersigned affirms that all material furnished by the, <br />undersigned has boon paid for, and all subcontractor~ employed by the undersigned have been paid in full, EXCEFT: <br />NOTE: if lliis instrument is executed by a corpora- <br />tion, it must be signed by an officer, and if <br />executed by a partnership, it must be signed <br />by a partnar.-- <br />T REdEASE N!{I.l BF l 1cTl�i ONLY To <br />1A16iEt l Q{lpq }�Y GAys MOM <br />By <br />(ride) l <br />tnp test <br />i ,Y1;WWI C <br />I <br />