VA Final Waiver of Liens 1995

Date: _______________

Original Contract Amount: $_________________

Previous Payments: $_________________

Current Payments: $_________________

Contract Balance: $_________________

STATE OF VIRGINIA _______________________

COUNTY OF FAIRFAX ______________________ ; To wit:

KNOW ALL MEN THAT __________________________________________, for and in consideration of, the sum of _____________________________________, in payment of invoice or application dated __________________________________, does hereby waive, release and relinquish any and all claims of lien which _______________________ now has upon the premises known and described as ____________________________________________________________________, ____________________________________________________________________

for labor, materials and services furnished prior to ____________________________________________________________________

said premises being owned by _________________________________________

__________________________________________________________________

By:

Subscribed and sworn to before me this _____ day of ____________, 20_____.

_____________________________________

Notary Public

My Commission Expires: _________________