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12419 Pine Street • P.O. Box 590 <br />Becker, MN 55309-05:41) <br />SEWER WATER & EXCAVATION <br />RECEIPT AND WAIVER OF MECHANIC'S LIEN RIGHTS <br />Dated, <br />The undersigned tiereby acknowledges receipt of the sum of $ 3 Q�� <br />CHECK ONLY ONE <br />l) as paziai payment for labor, skill and material furnished <br />2) F� as t aymem for all labor, skill and material furnished or to be furnished (except the sum of <br />$a__------ __._ _—_retainagc or holdback) <br />3) as &I and final payment for all labor, skill and material furnished or to be furnished <br />to the following ascribed real property., (legal description, street address or project name) <br />Office 76 3-2F2-04Jf-1 <br />Fax 763-262-043 <br />and for value rued hereby waives all rights acquired by the undersigned to file orrecord mechanic's liens against <br />said real properWhrlabor,skill ormaterial fumishedtosaid realproperty (onlyforthe amount paid ifBox 1 is checked, <br />and except for toWnage shown if Box 2 is checked). The undersigned aifinns that all material famished by the <br />undersigned has•bmn paid for, and all subcontractors employed by the undersigned have been paid in full, EXCEPT: <br />MOTE: I€ this moment is executed by a corpora-- <br />Lion, itareast be signed by an officer, and if <br />execugh by a partnership, it must be signed <br />--- byar-- - - --— -� <br />SAS <br />1.2 Ll I�uk4 -iO <br />Address) 1 j <br />��Cr� mr1 <br />