RELEASE OF LIEN RIGHTS FOR LABOR
   

Dated this ___________ day of ____________, 200__
(This date must concide with invoice) 
  

   The undersigned hereby waives and releases any and all lien or claim of right of lien against the property described herein and improvements thereon on account of labor performed in the construction of said buildings and for improvements incident thereto. 
   
   Each of the undersigned hereby certifies that he has been paid in full for all work of whatsoever nature, which he has performed on the above described job:
   

 RECEIVED PAYMENT IN FULL TO DATE

1 　 11 　
2 　 12 　
3 　 13 　
4 　 14 　
5 　 15 　
6 　 16 　
7 　 17 　
8 　 18 　
9 　 19 　
10 　 20 　
   FOR THE PURPOSE OF OBTAINNING PAYMENTS for the above items, the undersigned subcontractor hereby certifies and warrants that the above named laborers and mechanics actually performed work and labor upon the job hereinbefore set forth and have actually been paid in full to date. The undersigned further certifies and warrants that the above is a full and complete list of all laborers and Mechanics who performed work for him upon this job.
  

______________________________
Original Contractor/Sub Contractor