What type of information is required on the blank spaces in the form below? For Items #1-7
WAIVER OF LIEN
To whom it may concern:
WHEREAS the undersigned _________________________________________________
Was employed by ____________________________ to furnish labor, material, and/or equipment for the premises known as__________________________________located at ___________________________.
NOW, THEREFORE, the undersigned for and in consideration of monies and other goods and valuable considerations received through the period up to, and including ?#1_______ receipt of which is hereby acknowledged, hereby waives and releases any and all liens or claims or right of lien on said premises on accounts of labor or materials or both, furnished by the undersigned for said premises.
IN WITNESS WHEREOF the undersigned has set its/his hand and seals this ________Day of
______________, 2019 Notary Seal #3?
_________________________#2_? President of company signs ?
In the presence of
On this __________________day of _________________2019 before me the undersigned a Notary Public in and for said County, personally came _?#4??________________________ of
_______________#5??______________to me known personally to be the ____#6??_____________
of said Corporation and the identical person whose name is affixed to the above instrument, and acknowledged the execution thereof to be his voluntary act and deed as such officer and the voluntary act and deed of the said ______#7??_________________________, and that the corporate seal of the said _____________________________________, was thereto affixed by its authority.
WITNESS my hand and notarial seal at ______________________, New York in said County the day and year last above written.
My commission expires_____________