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-HavNew eaffstlylemolf eel. <br />SEWER WATER & EXCAVXTION� <br />'MoForm No. 120-M (1031 ) <br />RECEIPT AND WAIVER OF MECHANIC'S LIEN RIGHTS <br />Dated: <br />124 19 Pine Street • P.O. Box 590 <br />- _ Becker, MN 55308.0590 <br />Office 763-262.0430 <br />Fax 763-262.0432 <br />Mfllor•Davle Co,, ml nn000lie (10. -, 6) <br />i4tinnesn�a tlni(Omt c)enveyancing Blam (I gas) <br />The undersigned hereby acknowledges receipt of the sum ors l`i� <br />CHECK ONLY ONE --- - <br />1) D as Partial payrrlertt for labor, skill and material furnished <br />2) as payment for all labor, skill and material furnished or to be furnished (except the sure of <br />S--- — - — — — -- - - ----mtainage or holdback) <br />3) as full and final payment for all labor, skill and material furnished or to be furnished <br />to the following described real propel,. (legal description, street address or project name) <br />e(��(`A1 <br />and For value mceived hereby waives all rights acquired by the undersigned to file orrecond mechanic's`liens against <br />said real property forlabor, skill orrnaterial furnished to said teal In forthe amountpaid if Box 1 is checked, <br />and except for rctainagc shown if Box 2 is checked}, The undersigned affirms that all material furnished by the <br />undersigned has been paid for, and all subcontractors employed by the undersigned have been paid in full, EXCEPT: <br />NOTE: if this instrument is executed by a corpora - <br />lion ', it must be signed by an officer, and if <br />executed by a partnership, it must be signed <br />- - — by a partner--- - - <br />�%751 i94i.b Ci' rTIS � iPli <br />T OF PAYMENTS AGTilfillY RECEYEli WMM AV <br />ALIPTCY HUNG Fi111411I M BAM <br />By <br />{ride) ' <br />tAd&RFJ <br />