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IT <br />SEWER WATER & EXCAVATION <br />RECEIPT AND WAIVER OF MECMANIC'S LIEN RIGHTS <br />Dated: <br />12419 Fine Street • P.O. Box 590 <br />Seeker, _M_M 55306-05:-'r1 <br />Office 7632262-0-U1 <br />Fax 763.262.043? <br />-39 <br />1ne undersi ed hereby acknowledges receipt o f the sum of � - �( -- <br />CHECK ONLY ONE <br />1) as paatial payment for labor, skill and material furnished <br />2) as oyment for all labor, skill and material fumished or to be furnished (except the sum of <br />$ retaittage or holdback) <br />3) as lull and final payment for all labor, skill and material furnished or to be Furnished <br />to the following dewribed real property: (legal description, street address or project name) <br />e d j <br />and for value retoied hereby waives all rights acquired by the undersigned to file orr=Fd mechanic's liens against <br />said real propertf1abor;skillormaterialfurnishedtosaidrealproperry(onlyfortheamountpaidifBox1ischecked, <br />and except for "-rage shown if Box 2 is checked). The undersigned :affirms that all material furnished by the <br />undersigned ha-bwn paid for, and all subcontractors employed by the undersigned ]rave been paid ii.n frill, EXCEPT: <br />r—Nbdt: If <br />s rument is executed by a corpora <br />tiort, j mst be signed by an officer, and if <br />execs4 by a partriership, it must be signed <br />/.l <br />BY <br />(rift) <br />I <br />