Form 116 "Lien Release Form" - Montana

What Is Form 116?

This is a legal form that was released by the Montana Department of Administration - a government authority operating within Montana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2019;
  • The latest edition provided by the Montana Department of Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 116 by clicking the link below or browse more documents and templates provided by the Montana Department of Administration.

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Download Form 116 "Lien Release Form" - Montana

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Clear Form
STATE OF MONTANA
DEPARTMENT OF AD MI NISTRAT ION
ARCHITECTURE AND ENGINEERING DIVISION
1520 East Sixth Avenue • P.O. Box 200103 • Helena MT
59620-0103 Phone: 406 444-3104 • Fax: 406 444-3399
LIEN RELEASE FORM
Project Name:
A/E #:
Location:
Date:
To:
Attention:
From:
Attention:
UNCONDITIONAL RELEASE
CONDITIONAL RELEASE
The undersigned does hereby acknowledge that the
The undersigned does hereby acknowledge that upon
undersigned has been paid and has received progress
receipt by the undersigned of a check from:
payments in the sum of:
(name of firm providing payment)
(amount of compensation)
in the sum of:
for labor, services, equipment or materials furnished to the
above referenced job and does hereby release pro tanto
(amount of compensation)
any and all claims and rights of lien which the
and when the check has been properly endorsed and has
undersigned has on the above referenced job.
This
been paid by the bank upon which it was drawn, this
release covers all payment for labor, services, equipment,
document shall become effective to release pro tanto any
materials furnished and/or claims to the above referenced
and all claims and rights of lien which the undersigned has
job through:
on the above referenced Project. This release covers a
progress payment for labor, services, equipment; materials
(date)
furnished and/or claims through:
only and does not cover any retention or items furnished
(date)
after that date.
Notice: this document waives rights unconditionally and
only and does not cover any retention or items
states that you have been paid for giving up those rights.
furnished after this date.
This document is enforceable against you if you sign it
I CERTIFY UNDER PENALTY OF PERJURY UNDER
even if you have not been paid. If you have not been
LAWS OF THE STATE OF MONTANA THAT THE ABOVE
paid, use a conditional release form.
IS A TRUE AND CORRECT STATEMENT.
Signature:
Signature:
(of Authorized/Corporate Officer/Partner/Owner)
(of Authorized/Corporate Officer/Partner/Owner)
(print name)
(print name)
(title)
(title)
January
January
,
Dated this
Dated this
Day of
Day of
,
at
at
this
(city, state)
(city, state)
Dated this
Form 116
Lien Release Form (Rev 3/19)
1 of 1
Clear Form
STATE OF MONTANA
DEPARTMENT OF AD MI NISTRAT ION
ARCHITECTURE AND ENGINEERING DIVISION
1520 East Sixth Avenue • P.O. Box 200103 • Helena MT
59620-0103 Phone: 406 444-3104 • Fax: 406 444-3399
LIEN RELEASE FORM
Project Name:
A/E #:
Location:
Date:
To:
Attention:
From:
Attention:
UNCONDITIONAL RELEASE
CONDITIONAL RELEASE
The undersigned does hereby acknowledge that the
The undersigned does hereby acknowledge that upon
undersigned has been paid and has received progress
receipt by the undersigned of a check from:
payments in the sum of:
(name of firm providing payment)
(amount of compensation)
in the sum of:
for labor, services, equipment or materials furnished to the
above referenced job and does hereby release pro tanto
(amount of compensation)
any and all claims and rights of lien which the
and when the check has been properly endorsed and has
undersigned has on the above referenced job.
This
been paid by the bank upon which it was drawn, this
release covers all payment for labor, services, equipment,
document shall become effective to release pro tanto any
materials furnished and/or claims to the above referenced
and all claims and rights of lien which the undersigned has
job through:
on the above referenced Project. This release covers a
progress payment for labor, services, equipment; materials
(date)
furnished and/or claims through:
only and does not cover any retention or items furnished
(date)
after that date.
Notice: this document waives rights unconditionally and
only and does not cover any retention or items
states that you have been paid for giving up those rights.
furnished after this date.
This document is enforceable against you if you sign it
I CERTIFY UNDER PENALTY OF PERJURY UNDER
even if you have not been paid. If you have not been
LAWS OF THE STATE OF MONTANA THAT THE ABOVE
paid, use a conditional release form.
IS A TRUE AND CORRECT STATEMENT.
Signature:
Signature:
(of Authorized/Corporate Officer/Partner/Owner)
(of Authorized/Corporate Officer/Partner/Owner)
(print name)
(print name)
(title)
(title)
January
January
,
Dated this
Dated this
Day of
Day of
,
at
at
this
(city, state)
(city, state)
Dated this
Form 116
Lien Release Form (Rev 3/19)
1 of 1