Final Payment Affidavit and Lien Release

Final Payment Affidavit and Lien Release
Complete this form to certify final payment and release of lien rights for the specified project.
Project/Property Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Contractor/Company Name
Owner/Client Name
Contact Email
example@example.com
Final Payment Amount (USD)
Date of Final Payment
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Affidavit Statement and Lien Release
By signing below, I affirm that all payments have been received and hereby release any and all lien rights related to the above project.
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