RD 1924-10 Release by Claimants

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Form Approved OMB
No. 0575-0042
Exp. Date: MM/DD/YY

USDA
Form RD 1924-10
(Rev. 1-98)

RELEASE BY CLAIMANTS
The undersigned, having received payment in full for all labor, materials, supplies, or equipment supplied to
, Contractor,

or to any subcontractor, in the construction or repair of the improvements upon the property located at:

, and furnished in the execution and fulfillment of contract between said Contractor and
Owner, dated
, do (does) hereby release and waive any and all claims,

liens, and lien rights, of any kind, nature, or description whatsoever, against said property and the Owner thereof, and against said
Contractor.
Lien or Claimant

Work or Materials

Date

Amount

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a
collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB
Control Number. The OMB Control Number for this information collection is 0575-0042. Public reporting for this collection of information is estimated to be
approximately 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, completing and reviewing the collection of information. All responses to this collection of information are voluntary. However, in order to obtain or
retain a benefit, the information in this form is required under Section 7 CFR 1924-A, Planning and Performing Construction and other Development. Rural
Development has no plans to publish information collected under the provisions of this program. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Rural Development
Innovation Center, Regulations Management Division at [email protected]

POSITION 6
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RD 1924-10 (Rev. 1-98)
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