RUS Form 224 Waiver and Release of Lien

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U.S. Department of Agriculture
Rural Utilities Service

WAIVER AND RELEASE OF LIEN

WHEREAS the undersigned,
NAME OF MANUFACTURER, MATERIAL SUPPLIER OR SUBCONTRACTOR

has furnished to

the following:
NAME OF CONTRACTOR

for
KIND OF MATERIAL AND SERVICES FURNISHED

use in the construction of a project belonging to
NAME OF BORROWER

and designated the Rural Utilities Service as
RUS DESIGNATION

NOW, THEREFORE, the undersigned,
NAME OF MANUFACTURER, MATERIAL SUPPLIER, OR SUBCONTRACTOR

and other good and valuable
for and in consideration of $
consideration, the receipt whereof is hereby acknowledged, do(es) hereby waive and release any and all liens, or
right to or claim of lien, on the above described project and premises, under any law, common or statutory, on
account of labor or materials, or both, heretofore or hereafter furnished by the undersigned to or for the account of
for said project .

said
NAME OF CONTRACTOR

Given under my (our) hand(s) and seal(s) this

day of

,20

.

Name of Manufacturer, Material Supplier, or Subcontractor

By
President
This Waiver and Release of Lien must be signed with the full name of the Manufacturer, Material Supplier, or Subcontractor. If the Manufacturer,
Material Supplier, or Subcontractor is a partnership, this Waiver and Release of Lien must be signed in the partnership name by a partner. If the
Manufacturer, Material Supplier, or Subcontractor is a corporation, this Waiver and Release of Lien must be signed in the corporate name by a
duly authorized officer and the corporate seal affixed and attested by the Secretary of the Corporation.

RUS FORM 224 (Rev. 2-04)