NORTH CAROLINA HOUSING FINANCE AGENCY
Urgent Repair Program
Contractor's Release of Liens
A. Sub-contractor's and Supplier's Certification
WHEREAS we, the undersigned sub-contractor(s) and/or supplier(s), have furnished the materials and
work for the repair of the dwelling unit described below:
HOME OWNER:
ADDRESS:
PRIME/GENERAL CONTRACTOR:
CONTRACT DATE:
WHEREAS we, the undersigned sub-contractors and suppliers, have agreed to release all liens which we,
or any of us, have, or might have on the said buildings for work or materials contracted for or furnished
in, for, or about the repairing or modification of the said building.
WITNESSETH, that we, the undersigned sub-contractors and suppliers, do hereby certify that all work
required to be done by us in association with the above-referenced contract has been done in good and
workmanlike manner in accordance with the terms thereof, and that we have been paid or definite
arrangements have been made for us to be paid by the prime/general contractor;
WITNESSETH, that we, the undersigned sub-contractors and suppliers, do hereby release any and all
claims for damages, loss or amounts owed or claimed to be owed by either the Contractor or Homeowner
as a result of the above contract and work done thereunder.
IN WITNESS WHEREOF, we hereunto set our hands and seals, on the date written opposite our
respective signatures:
(1)
Date Sub-contractor/Supplier
By:
Witness Authorized Signature
(2)
Date Sub-contractor/Supplier
By:
Witness Authorized Signature
(3)
Date Sub-contractor/Supplier
By:
Witness Authorized Signature
(4)
Date Sub-contractor/Supplier
By:
Witness Authorized Signature
(5)
Date Sub-contractor/Supplier
By:
Witness Authorized Signature
B. Prime/General Contractor's Certification and Request for Payment:
I do hereby certify to the Owner of the above property that the signatures signed to this Release of Leins
comprise a true and complete list of all corporations and persons who have contracted for or furnished
any and all repairs or improvements of the said building(s) or premises, or who are, or have been, sub-
contractors upon said building(s) or any part thereof or for any furnishing and any and all fixtures or
improvements to said real estate under any contract or agreement with the undersigned.
Upon receipt of payment of the balance due under the contract this document shall become effective to
release all liens which I, the undersigned, have or might have on the said buildings for work or materials
contracted for or furnished in, for, or about the repairing or modification of the said building. Payment
shall be considered received when the related payment check has been properly endorsed and has been
paid by the bank upon which it is drawn.
I hereby request payment of the balance due under the contract.
Contractor Date
Authorized Signature
Title
Witness
