What type of information is required on the blank spaces in the form below? For Items #1-7

8 months ago


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 ?

By: __________________________

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_____________

Senior Legal Associate Levelset
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Unfortunately, I’m not able to instruct you on how to fill out any given form here on the Expert Center. While I can provide helpful legal information, I’m not able to provide you with legal advice.

However, note that Levelset does provide free, downloadable New Jersey lien waiver forms which might be a little easier to navigate, plus there are guides which are included alongside the waivers which help to breakdown different sections of the form. You can find those here after scrolling down a bit: New Jersey Lien Waivers Guide and FAQs.

Further, it’s also worth noting that mechanics liens almost never need to be notarized, as a matter of law. Lien waivers in New Jersey and New York don’t have to be notarized in order to be valid (notarization is only required in Texas, Mississippi, or Wyoming). More on that here: Do Lien Waivers Need to be Notarized?

Disclaimer: The information presented here is not legal advice and should not be construed as such. Rather, this content is provided for informational purposes. Do not act on this information as if it is advice. Further, this post does not create any attorney-client relationship. If you do need legal advice, seek the help of a local attorney.
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