2007-11-06 Mechanic's LeinBlaine Rentals, LLC.
Box 284
St. Cloud, MN 56302
Fax 320- 253- 4991
RECEIPT AND WAIVER OF MECHANIC'S LIEN RIGHTS
DATED : //" 6 _ D
The undersigned hereby acknowledges receipt of Check # 2141 for the Sum of $ 15,800.00
Check one only:
1) [ ] as partial payment for labor, skill and material furnished and
2) [ ] as payment for all labor, skill and material furnished or to be furnished ( except for the sum of
$ retainage or holdback ) and
3) [ X ] as full and FINAL PAYMENT for all labor, skill and materials furnished or to be furnished
For 2007 reclaim & reconstruct street section at 601h Street NE
For value received, the undersigned does hereby waive their rights and claims for lien on land and buildings
about to be erected, being erected, erected, altered or repaired and to the appurtenances thereonto for:
Blaine Rentals, LLC., Owner, by the undersigned contractor for real property being situated at in the City of
Albertville, Wright County, State of Minnesota , described as follows: partial; Lot], Block 1, Field Plaza
Subdivision.
Address : 11166 Cty Rd 37. Albertville MN 55301
for all labor performed and for all materials furnished for the erection, construction, alteration or repair of said
building and appurtenances to said real property (only for the amount paid if box #1 is checked, and except
for retainage shown if box #2 is checked). The undersigned affirms that all material and labor furnished by
them have been paid in full.
Omann Brothers Paving Inc
Note: By: oe ;
If this instrument is executed by a
corporation or a partnership, it must Title:
be signed by an officer, partner, or
a duly authorized agent. Address: (,SS1 L�,3t-1 je
A&Ot +T-yt LLe / MA} 5-534 t
Please sign and return or Fax to LCI at the above address.