HomeMy WebLinkAbout04-0239WAIVER OF LIEN
MATERIAL OR LABOR
STATE OF
COUNTY OF
DECEI~EI! 12, 2003
To All Whom II May Concern: /~,,~'~,.c~
Whereas the undersigned CRC C]GqEIUL~ CON~ACTOR, INC.
has been employed by V~CTJ[.,A~'~ HOSE CO. ~I/CD)~E~ VA/gr.,E~ HOSE CO. 22
General Contractor/Owner
to furnish labor and/or materials for ADDITION TO SR[PP~SB~C FIRE FIG~'I'F-.KS ACi'IV/I~ BITiLDING
Nature of the Work
for the Building and Premises known as SH[PPENSBU][G FI'R~ FII.;ItTF.;][{S AC'['IVIT~ C][tl3;F,K
At ORANGE AND SENECA STREETS
Address
In SHIPPENSBVRG, CI~BEIU~.I~ CO[TN'I~, PENNSYLVAIq[A
City', County, State
Lot No. Section Township Range
Now, Therefore, Know Ye, That G'~C GgNE~C,a,~ C01~"RACTOR, INC. the undersigned
for and in consideration of the sum of 01~TE DOLT.AR Dollam
and other good and valuable considerations, the receipt whereof is hereby acknowledged, do hereby waive end release any and
aU lien, or claim or right to lien on said above described building and premises under the Statutes of the State of
relating to Mechanics' Liens. on account of labor or materials, or both, furnished or which may be furnished, by the undersigned
to or on account of the said firm or individual therein named for said building or premises.
Witness:
12£h day of DEC~I~BER A.D. ~ 2003
By MJ JA~ES
Title PRESIDENT
(SEAL)
(SEAL)
Subscribed and sworn to before me this
12th Day Of DECEIq~EI~ ~ 2003
AP]LTL ]*5, 200/~
,)/~Expires
Np(ary Public