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ss tht owner of real grgperty situate in ~ County, Florida, to-wit:
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has mo gaged the same to to secure a loan in the amount of
s ,the proceeds of which are to be, or have been used in the construction or repair of improve-
. me is upon said real estate; and
WHEREAS, said : is required by law to secure-its loans by first lien upon.improveef~eal estate; ~
NOW THEREFORE, in consideration of the sum of One Dollar to each of us in'hand.paid, ieceipt whereof i;eie-
by acknowledged, and other benefits atuuing to us, and in order to induce the mortgagee to disburss fhe brn proceeds,
we do hereby waive, release and suit-claim any and all right that we, or any of us, may now or hereafter have to claim
a lien against said land and improvements thereon in accordance with Section 81.201 (2), Florida Statutes; and we do
further warrant that -we have not end will not assign our claim for payment, nor our right to perfect a lien against said
property, and that we-have the rtghrto execute this -waiver and release of-iien_ ~ ~ - - - - -
Each of the subscribers to this instrument respectively warrants that all laborers by them employed upon the
aforesaid premises have been fully paid and hold no claim, demand, or I:en against said premises; and further, that no
Chatbl Mortgage, Conditional. Bill of Sale, or Retention of Title Agreement has been given or executed for or in connec-
tion with any material, appliances, machinery, fixtures, or furnishings placed upon or installed in the aforesaid premises,
other them
It is warrantted that any and all signatures hereto are for all services rendered, wort done, and. material furnish
ed heretofore by the signers iA any and all cApacities, and are rwt understood to be only for rile particular item against
which the signature is affixed. .
- WITNESS the following signatures and seals, this _ day of _ - _ _ : , A D ~19 _
~~ss11~~n~t~of Claim - A nt of Claim
~~/~1197pR UNPMD AI UNPAID -
land Preparation Equipment
'~cy~kS ?S_hou•uo _ v~ Tic
I~~(~ Labor, Floes b Wails _ Air Conditioning b Heatiny
Roo ing ~ Lumber b Wood Materials
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Septic Tank G.' , lumber bWood/ Materiels
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~ Plumbing lumber b Wood Materials
S__I J ~'d~ ~ C~ 3 ~3 D~ 12trlfC~,r~L /~a~~ricitt 4
EI rival Concrete Products -
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ing Concrete Products
P sterirq Painting -labor
? s ~ `{1.~o Co.J,~sk~-wry s a~o~r_.~ _
Tile Work Painting -Materials
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Gbinet: Labor
~ Fbon Labor
- ` Windows ~ Labor
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