CONDITIONAL WAIVER AND RELEASE UPON FINAL PAYMENT
    

Upon receipt by the undersigned of a check from ___________________________
(Maker of Check) in the sum of $___________ payable to ____________________
(Payee or Payees of Check) and when the check has been properly endorsed and has been paid by the bank upon which it is drawn, this document shall become effective to release any mechanic’s lien, stop notice or bon right the undersigned has on the job of :
         _______________________(Owner) located at   

         ____________________________________________(Job Address).

This release covers the final payment to the undersigned for all labor, service, equipment or material furnished on the job, except for disputed claims for extra work in the amount of $___________.

Before any recipient of this document relies on it, said party should verify evidence of payment to the undersigned.