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- - ---- _ -- -- - - - __ . . <br />-- --- ---__ ----__: -- <br />, EXHIBIT'G' <br />AFFIDAVIT~ LIEN WAIVER AND RELEASE <br />Page 1 of 1 <br />AFFIDAVIT, LIEN WAIVER AND RELEASE <br />1. With reference to construction of on the site <br />at , Salem, Oregon (the "Project"), the undersigned for value <br />received, acknowledges that it has been paid in full for all labor, services, equipment and materials <br />provided or transported in connection with the Project through , 199_, except <br />retainage, if any, and hereby fully and unconditionally waives and releases any and all right to <br />payment, liens, claims of lien, rights to lien, bond claim rights, or any other claims or demands for <br />labor, services, equipment, materials provided or transported in connection with the Project <br />through said date except retainage, if any, and except: <br />2. The affiant below dces hereby swear and attest that he/she has full authority to sign this <br />document on behalf of the undersigned company and that the undersigned company has paid in full <br />all its subcontractors, suppliers and consultants for labor, services, equipment, materials provided <br />or transported in connection with the Project through the date referenced in paragraph 1 above. <br />The undersigned ~ant and company further acknowledge that Owner and its lenders or financing <br />sources are relying on this Affidavit, Lien Waiver and Release in connection with processing and <br />authorizing funding requests and requests for paymen~ ~ <br />3. On condition that ~nal payment in the amount of $ is received, the <br />undersigned waives and releases all liens, claims of lien, rights to lien, bond claim rights, or any <br />other claims or demands for payment it may have arising out of or relating to the Project. <br />Dated this day of <br />COMPANY: <br />By: <br />Tide: <br />STATE OF OREC'~ON ) <br />) ss. <br />County of Marion ) <br />199_. <br />The foregoing instrument was acknowledged before me this day of , <br />1999, by [if signed on behalf of an entity, complete the <br />following: of (insert name of Company) a (insert <br />type of entity, eg corporation) on behalf of the (type of entity).] <br />Notary Public for Oregon <br />My commission expires: . <br />