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Ontract Amount Value Completed to Date Less Retainage 10 % Total Less Retainage Less Previous Requests Amount of This Request for Payment $ $ $ $ $ $ $ $ State of: County of: The Undersigned, for and in consideration of payments previously received from Allstate Construction, Inc. and other good and valuable consideration, and in order to induce the above mentioned payment, does hereby waive, release, remise and relinquish the undersigned’s right to claim, demand or impose any lien or liens .

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