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Form No. 120-M (1031) <br /> <br /> oF c c's <br /> <br /> The 'undersi~ h~eby ac~owledg~ re.pt of the ~m of $ <br />C~CK ONLY O~ <br /> <br />1) ~ as p~i~ pa~t for l~or, s~H ~d ~tefi~ ~shed <br /> <br />2) <br /> <br />[] as payment for all labor, skill and material furnished or to be furnished (except the sum <br /> of $ retainage or holdback) <br /> <br />3) [] <br /> <br />as full and final payment for all' labor,, skill and labor material furnished' or to be <br />furnished to the fox, wing described real property. (legal description, street address or <br />project name) <br /> <br />and for value received hereby waives all fights acqUired by the undersigned to file or record <br />mechanic's liens against said real property for labor, skill or material furnished to said real <br />property (only for the mount paid if Box 1 is checked, and except for retainage shown if Box 2 is <br />checked). The undersigned affirms that all material furnished by the undersigned has been paid <br />for, and all subcontractors employed by the undersigned have been paid in full, EXCEPT: <br /> <br />l~4we,t Painting & DrTwltll <br /> <br />O~rller <br /> <br /> (Tree) <br />788 Wat~x;m Avenue <br /> <br />St. Piml, MN 55102 <br /> <br />Note: <br /> <br />If this instrument is executed by a <br />Corporation, it must be signed by an <br />officer, and if executed by a partnership <br />it must be s/gned by a panner <br /> <br />:::~NI±NIVd ±S3ffi~IN <br /> <br />-123- <br /> <br /> <br />