Showing results for 
Search instead for 
Did you mean: 
Community Contributor *

Final Release Affidavit of Payment Form VA

Payments checks received cleared $6750.00

Contract Amount $7,500.00

Retention $ 750.00


How do I fill out a VA Affidavit of Payment and Final Release of Liens excluding retention amount 


NOW, THEREFORE, for and in consideration of, and contingent upon, receipt of the sum paid-to-date of $                          , this check amount being $                    , paid by , the undersigned hereby releases, waives and discharges any rights or claims, including but not limited to, lien rights the undersigned now has or may have against the Property,  its successors, assigns and sureties, and the Owner, its successors, assigns and sureties, arising out of or relating to the Project on account of labor performed, work done and material furnished thereon up to the sum paid herein.


The undersigned certifies that all of its subcontractors, suppliers, laborers, materialmen and any other person or entity which has provided labor, material or other services for the Project have been paid in full or will be paid in full from the proceeds of the sums being paid by  herein.  The undersigned further certifies that all Social Security taxes, withholding taxes, sales and use taxes, Workmen’s Compensation taxes and insurance premiums which have been accrued in connection with the Project, have been fully paid and discharged.


The releases and certificates made herein by the undersigned are for labor performed, work done and/or material furnished by or on behalf of the undersigned through the period ending the              day of

                          , 2019.  This release does not include a release of liens as to the amounts owning for any retention as provided for in the contract between  and the undersigned. A photocopy, facsimile or electronic copy of this signed release shall have the same binding effect as the original.

1 Comment
Community Backer **

Re: Final Release Affidavit of Payment Form VA

This release is pretty clear cut.  The last paragraph mentions the retention.  The best thing is to contact your attorney for legal-speak.