Form DOA-4530 at a glance
What it is: Form DOA-4530 of the State of Wisconsin Department of Administration, Division of State Facilities, is the Waiver of Lien on Final Payment for Labor and Materials under s. 779.15 Wisconsin Statutes.
Who signs: The undersigned signs on the Authorized Signature line and enters the Printed Name and the Title; the Notary Public signs on the Notary Public line, where the form is Subscribed to and Sworn before me.
A filled-in Form DOA-4530 example: a firm waives its lien
How to fill out Form DOA-4530, box by box
Project Title, Project Location and Firm Name
Fill in the ATTN Project Manager, the REF CONTRACT PROJECT NO., the Work Description and the Project Title. Fill in the Project Location and the Firm Name.
The waiver of lien and the Authorized Signature
Enter the Street, City, County, State and Zip+4 after Of, and the Name of Firm or Organization Contracted With after Have been employed by. The undersigned state that they have been paid in full or all obligations have otherwise been satisfied and are hereby acknowledged, and waive and release any and all lien, and claim or right to lien on the money or bonds or warrants due or to become due the prime contractor, all in accordance with State of Wisconsin Statute 779.15. Sign on the Authorized Signature line.
Telephone Number and Fax Number and the Notary Public
Enter the Telephone Number and Fax Number. The Notary Public fills in On this, day of and 20 where the form is Subscribed to and Sworn before me, and signs on the Notary Public line.
My Commission expires
The Notary Public fills in My Commission expires , 20.
More rules for Form DOA-4530
Mailing Address: Post Office Box 7866, Madison, WI 53707-7866; Street Address: 101 E. Wilson Street, 7th Floor, Madison, WI 53702; Phone: 608 / 266-2731; FAX: 608 / 267-2710.
This form can be made available in accessible formats upon request to qualified individuals with disabilities.
Sources
[1] Form DOA-4530 (R01/96), Waiver of Lien on Final Payment for Labor and Materials, State of Wisconsin Department of Administration (the Official source link on this page).
