INTERIM WAIVER AND RELEASE
UPON PAYMENT

STATE OF GEORGIA

COUNTY OF ________________

The undersigned mechanic and/or materialman has been employed by ____________________________ (name of contractor) to furnish ____________________________ (describe materials and/or labor) for the construction of improvements known as___________________________ (title of the project or building) which is located in the City of ____________________, County of ____________________, and is owned by ____________________________ (name of owner) and more particularly described as follows:

[Legal Desc. Here]

 

 

 

(DESCRIBE THE PROPERTY UPON WHICH THE IMPROVEMENTS WERE MADE BY USING EITHER A METES AND BOUNDS DESCRIPTION, THE LAND LOT DISTRICT, BLOCK AND LOT NUMBER, OR STREET ADDRESS OF THE PROJECT.)

Upon the receipt of the sum of $____________, the mechanic and/or materialman waives and releases any and all liens or claims of liens it has upon the foregoing described property through the date of ____________ (date) and excepting those rights and liens that the mechanic and/or materialman might have in any retained amounts, on account of labor or materials, or both, furnished by the undersigned to or on account of said contractor for said building or premises.

Given under hand and seal this ________ day of ____________, 20____.

 

___________________________ (Seal)

 

________________________

________________________

(Witness)

________________________

(Address)

Provided, however, that the failure to correctly complete any of the blank spaces in the above form shall not invalidate said form so long as the subject matter of said release may reasonably be determined.