74-01 - Trolls Glen 2nd Add SUB pt 6[4o. 1031 (Rev. 1%2)
Miller -Davis Co., Minneapolis
RECEIPT AND WAIVER OF MECHANICS' LIEN RIGHTS
N. B. It is important that the following directions be closely followed as otherwise the receipt
WILL NOT BE ACCEPTED.
1. This is a LEGAL INSTRUMENT and must be executed accordingly by officers of corpora-
tions and by partners of co -partnerships.
2. It is important that ALL the blanks be completed and that the AMOUNT PAID BE SHOWN.
3. If payment is not in full to date, so state. SHOW UNPAID BALANCE, and strike out last
three lines.
4. A receipt similar to this or legal waiver of lien rights will be required for all plumbing, heating
and plastering material, etc.
5. NO ERASURES OR ALTERATIONS MUST BE MADE.
The undersig acknowledges having received payment of...........
_............... ........� ''1.....:.... Ll..............................................................
(Am Paid)
from ........... ..'.../.._!�.r........ .....r...._.r................
.............. ............ .....................
(Name Payor)
all................c2:?J�°ei�''' e!e� ✓..
(Kind of "Material or Labor)
by the undersigned delivered or furnished to (or performed at)..
... ....... ...... .... ................ !' <':.....:.'.........................................................
(DATE)
....... .I.............DOLL,4RS
..................................................in full payment of
............................................................
(Street Address or Legal Description)
and for value received hereby waives all rights which may have been acquired by the undersigned to file
mechanics' liens against said premises for labor, skill or material furnished to said premises prior to the
date hereof.
1
.C.' / ^ ............ .
PLUMBING, HEATING and PLASTERING
By.. ...........:.�:....... .......................................
l
contractors must sign statement on reverse hereof ............