LPB 65-05(ir) Page 1 of 3 PARTIAL WAIVER OF LIEN The undersigned, having a right to a lien for labor performed on and/or materials furnished to the following described real estate in County, state of Washington, to-wit: Tax Parcel Number: TO , owner of the premises located at and known as and TO ALL WHOM IT MAY CONCERN: IN CONSIDERATION of the sum of Dollars ($), and other good and valuable considerations this day in hand paid, receipt whereof is hereby acknowledged, the undersigned, as contractor for the American LegalNet, Inc. www.FormsWorkFlow.com LPB 65-05(ir) Page 2 of 3 work (labor and materials) for the building now in the course of construction upon the above-mentioned premises, and/or otherwise improving said premises, hereby waives and releases all claims, liens and right to lien, for any and all work, labor and material by performed and furnished in, upon and about said premises under the terms of said contract, to and including the day of ; and the undersigned hereby acknowledges that all and singular payments heretofore received, and settlements made by on account of said contract, have been and are hereby accepted by the undersigned in full satisfaction of the claims, liens and right to lien, so far waived and released, irrespective of the form or forms of such payment and settlements. Dated: STATE OF ss. COUNTY OF I certify that I know or have satisfactory evidence that (is/are) the person(s) who appeared before me, and said person(s) acknowledged that signed this instrument, on oath stated that authorized to execute the instrument and acknowledge it as the of to be the free and voluntary act of such party(ies) for the uses and purposes mentioned in this instrument. Dated: Notary name printed or typed: Notary Public in and for the State of Residing at My appointment expires: American LegalNet, Inc. www.FormsWorkFlow.com LPB 65-05(ir) Page 3 of 3 STATE OF ss. COUNTY OF I certify that I know or have satisfactory evidence that (is/are) the person(s) who appeared before me, and said person(s) acknowledged that signed this instrument and acknowledged it to be free and voluntary act for the uses and purposes mentioned in this instrument.. Dated: Notary name printed or typed: Notary Public in and for the State of Residing at My appointment expires: American LegalNet, Inc. www.FormsWorkFlow.com