PARTIAL CONDITIONAL WAIVER STATE OF MICHIGAN (Pursuant …

PARTIAL CONDITIONAL WAIVER STATE OF MICHIGAN

(Pursuant to Michigan Compiled Laws ? 570.1115)

Claimant US Inc. ("Claimant") has a contract with: ______________________________________________________________________

(Claimant's customer/other contracting party) to provide labor, material, or services of the following general description: ______________________________________________________________________ ______________________________________________________________________ for the improvement to the property described as follows: ______________________________________________________________________ _____________________________________________________________________.

By signing this waiver Claimant hereby waives its construction lien rights to the amount of $_________________, for labor, materials, or services provided through ____________ (date).

This waiver, together with all previous waivers, if any, (circle one) does/does not cover all amounts due to Claimant for contract improvements provided through the date shown above.

If the improvement is provided to property that is a residential structure and if the owner or lessee of the property or the owner's or lessee's designee has received a notice of furnishing from Claimant, or if Claimant is not required to provide one, and the owner, lessee, or designee has not received this waiver directly from Claimant, the owner, lessee, or designee may not rely upon it without contacting Claimant, either in writing, by telephone, or personally, to verify that it is authentic.

This waiver is conditioned upon Claimant's actual receipt of payment in the amount of $_____________.

DATED on _______________, 20_____ _________________________________________ (Claimant name)

By: ___________________________________

Its: ___________________________________ Address:____________________________ ___________________________________ Phone: ____________________________ Fax: _______________________________

DO NOT SIGN BLANK OR INCOMPLETE FORMS. RETAIN A COPY.

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