GA Waiver and Release of Lien and Payment Bond Rights Upon Interim Payment

Waiver and Release of Lien and Payment Bond Rights Upon Interim Payment

STATE OF GEORGIA
COUNTY OF________

            The undersigned mechanic and/or materialman has been employed by _______________ (name of contractor) to furnish _______________________(describe materials and/or labor) for the construction of improvements known as __________________ (title of the project or building) which is located in the City of _________, County of _____________, and is owned by _______________ (name of owner) and more particularly described as follows:

__________________________________________________________________________________

(DESCRIBE THE PROPERTY UPON WHICH THE IMPROVEMENTS WERE MADE BY USING EITHER A METES AND BOUNDS DESCRIPTION, THE LAND LOT DISTRICT, BLOCK AND LOT NUMBER, OR STREET ADDRESS OF THE PROJECT.)

            Upon the receipt of the sum of $__________, the mechanic and/or materialmen waives and releases any and all liens or claims of liens it has upon the foregoing described property or any rights against any labor and/or material bond through the date of _________(date) and excepting those rights and liens that the mechanic and/or materialmen might have in any retained amounts, on account of labor or materials, or both, furnished by the undersigned to or on account of said contractor for said building or premises.

            Given under hand and seal this ____ day of __________, _____.

__________________________________(SEAL)

__________________________________    
Witness                                                         

__________________________________

__________________________________

(Address)

NOTICE: WHEN YOU EXECUTE AND SUBMIT THIS DOCUMENT, YOU SHALL BE CONCLUSIVELY DEEMED TO HAVE WAIVED AND RELEASED ANY AND ALL LIENS AND CLAIMS OF LIENS UPON THE FOREGOING DESCRIBED PROPERTY AND ANY RIGHTS REGARDING ANY LABOR OR MATERIAL BOND REGARDING THE SAID PROPERTY TO THE EXTENT (AND ONLY TO THE EXTENT) SET FORTH ABOVE, EVEN IF YOU HAVE NOT ACTUALLY RECEIVED SUCH PAYMENT, 90 DAYS AFTER THE DATE STATED ABOVE UNLESS YOU FILE AN AFFIDAVIT OF NONPAYMENT PRIOR TO THE EXPIRATION OF SUCH 90 DAY PERIOD.  THE FAILURE TO INCLUDE THIS NOTICE LANGUAGE ON THE FORM SHALL RENDER THE FORM UNENFORECABLE AND INVALID AS A WAIVER AND RELEASE UNDER O.C.G.A. § 44-14-366.