ST9302-CS010716 WA¥1ER 01= LIEN TO DATE
STATE OF TEXAS CTY#
OOUNTY OF TARRANT E~cr~w
TO WHOM IT MAY CONCERN':
ac~~, do(es) hereby waive and _re4e~e._. ~ any and an ~ (x clsim or, o~ dght to, Den, under the statutes c~ the
Sta~e of Texas, relating to mechenics' liens, with respe~ tO and on said above-described premises, end the
Improvements thereon, afxt on the materla~, fixtures, aDOaratus o~ macNrlery hjtrdshe~, and on the rnormys, funds
or ot~er corrsideratfons due from ttte owwer, on accou~ of Ail labor services, material, fixtures, epperetus or
machinery, furnished to this date by the undersigned for the ~-~aseribed prerrases, INCLUDING EXTRAS.'
CONTRACTOR'S AFFIDAVIT
STATE OF TEXAS
COUNTY OF TARFIANT
TO WHOM IT MAY CONCERN: ~ _ , ~ --
OF (COMPANY NAME)~.t~r-'~~ ~_J~_:~,~,-~ .~ WHO tS THE CONTRACTOR
FURNISHING ........ P_I~R DRILLJNG WORK ON THE ~U. ILDING LOCATED AT
That the total amount of the contract [flcJ, uding extras' is $ ~:~ i ~LCX:~. O(~ on which he or she
t'ms moeived payrne~ d $~ 1. [/_,~ ~i~ to tttis payment. Ttmt all waivers are true, correct and
genuine and delivered ur~onditi0nafly and that there is no claim eitt~er Iegal or eClURable to defeai fire valid/o/ot said
war, sets. 'Pnat tt-,e ~ am the nern~ ~ ad~'esses ol ail parties ~ ha~ it~rnisheci n~teda~ og ~ or bot, t~,
for said work and ail pa~s having contracts or stYo contracts for $l::~c~ l~ortio~s of sak/work or for material
entering into the C~o~struCtiOn lhereot and the amou~ due o~ to become due to each, and that the items mentioned
inctude ali labor and mate~at required to comgie~ said work according to plans and specl~'ations:
Names What lo~ Contract Amount This
~, ~j~ Prk~ paid Payment Due
TOTAL LABOR AND MATERIAL, INCLUDINO EXTRA8°, TO COMPLETE
That there are no other contracts for said work outstanding, and that there is nothing due c~ to become due to any
person for matmlal, labor or other work of any kind done or to be do. upon or ~rao~rmectlon with saki vmrk other than
.a, bove statect. ~f/
EXTRAS INCLUC~ BUT ARE NOT LIMFT'ED TO CHANGE O~~~N TO THE CONTRACT-
NOTAI:IY PUBLIC ,