HomeMy WebLinkAboutInv# APPLICATION #2 - A.D.A. Engineering, Inc. - 08/07/2021 (6)9/21/2021 PARTIAL RELEASE UPON PROGRESS PMT
https://nacmflorida.cicnetwork.com/weborl/wwiz.asp 1/2
WAIVER AND RELEASE OF LIEN
UPON PROGRESS PAYMENT
224921-OCEANPK
The undersigned lienor, in consideration of the sum of $10.00 hereby waives and releases its lien and right
to claim a lien for labor, services or materials, invoiced through 06-30-2021 to A.D.A. ENGINEERING
INC on the job of DANIA BEACH OPK (owner), to the following described property:
45 NORTH BEACH ROAD, DANIA BEACH, FL 33004; BROWARD COUNTY
This waiver and release does not cover any retention or labor, services or materials invoiced after the date
specified.
DATED on SEPTEMBER 21, 2021
FORTILINE INC - MIAMI #46
ATTN: TOM LONG
7025 NORTHWINDS DR NW
CONCORD NC 28027-3334
By:_____________________________________________
ELIZABETH PRUDEN
CREDIT COORDINATOR
Sworn to (or affirmed) and subscribed before me by means of [ ] physical presence or [ ] online notarization,
this 21 day of SEPTEMBER, 2021 by ELIZABETH PRUDEN (name of person making statement).
_______________________________________
Signature of Notary Public - State of Texas
_______________________________________
Print, type or stamp name of notary public
[ ] Personally Known OR [ ] Produced Identification
Type of Identification Produced _______________________________
This is a statutory form prescribed by Section 713.20, Florida Statutes 1996. Effective October 1, 1996, a
person may not require a lienor to furnish a waiver or release of lien that is different from the statutory form.
X
X