RUS Form 224 Waiver and Release of Lien

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According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0572-0107, which expires on XXXX. The time required to complete this information collection is estimated to average 1 minute per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection information. All responses to this collection of information are voluntary. Any questions on this burden can be sent to [email protected].

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

for and in consideration of $ and other good and valuable 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

said for said project _.

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.

Expires: XX/XX/20XX

RUS FORM 224 (Rev. 2-04)

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