Lien waiver · Mississippi

Mississippi lien waiver forms: the 3 statutory forms (2026)

By Oussama Chicha, EditorUpdated Checked against primary sources · not yet reviewed by a licensed professionalFact-checked
Quick answer

Miss. Code § 85-7-433 prints three Mississippi forms: an interim waiver and release upon payment, a waiver and release upon final payment, and an affidavit of nonpayment. They are mandatory: under § 85-7-419 a waiver and release has to substantially follow the interim or final form. Each is sworn before a notary. A waiver made in advance of furnishing labor, services or materials is null, void and unenforceable.

Mississippi · Lien waiverVerified 2026-09-29
Statutory forms
3
Force
Mandatory
Notarization
Required
Required: each waiver form and the affidavit of nonpayment is sworn to and subscribed before a notary public.
Text as of
2026-09-30

Interim waiver and release upon payment

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framingandfigures-mississippi-waiver-interim-payment.docx

INTERIM WAIVER AND RELEASE UPON PAYMENT STATE OF MISSISSIPPI COUNTY OF __________ THE UNDERSIGNED MECHANIC AND/OR MATERIALMAN HAS BEEN EMPLOYED BY __________ (NAME OF CONTRACTOR) TO FURNISH __________ (DESCRIBE MATERIALS AND/OR LABOR) FOR THE CONSTRUCTION OF IMPROVEMENTS KNOWN AS __________ (TITLE OF THE PROJECT OR BUILDING) WHICH IS LOCATED IN THE CITY OF __________, COUNTY OF __________, AND IS OWNED BY __________ (NAME OF OWNER) AND MORE PARTICULARLY DESCRIBED AS FOLLOWS: (DESCRIBE THE PROPERTY UPON WHICH THE IMPROVEMENTS WERE MADE BY USING EITHER A METES AND BOUNDS DESCRIPTION, THE LAND LOT DISTRICT, BLOCK AND LOT NUMBER, OR STREET ADDRESS OF THE PROJECT.) UPON THE RECEIPT OF THE SUM OF $__________, THE MECHANIC AND/OR MATERIALMAN WAIVES AND RELEASES ANY AND ALL LIENS OR CLAIMS OF LIENS IT HAS UPON THE FOREGOING DESCRIBED PROPERTY OR ANY RIGHTS AGAINST ANY LABOR AND/OR MATERIAL BOND THROUGH THE DATE OF __________ (DATE) AND EXCEPTING THOSE RIGHTS AND LIENS THAT THE MECHANIC AND/OR MATERIALMAN MIGHT HAVE IN ANY RETAINED AMOUNTS, ON ACCOUNT OF LABOR OR MATERIALS, OR BOTH, FURNISHED BY THE UNDERSIGNED TO OR ON ACCOUNT OF SAID CONTRACTOR FOR SAID BUILDING OR PREMISES. SIGNATURE BY: __________ (PRINT NAME) ITS: __________ (PRINT TITLE) SWORN TO AND SUBSCRIBED BEFORE ME, THIS THE __________ DAY OF __________, 20__________. NOTARY PUBLIC NOTICE: WHEN YOU EXECUTE AND SUBMIT THIS DOCUMENT, YOU SHALL BE CONCLUSIVELY DEEMED TO HAVE BEEN PAID IN FULL THE AMOUNT STATED ABOVE, EVEN IF YOU HAVE NOT ACTUALLY RECEIVED THE PAYMENT, SIXTY (60) DAYS AFTER THE DATE STATED ABOVE UNLESS YOU FILE EITHER AN AFFIDAVIT OF NONPAYMENT OR A CLAIM OF LIEN BEFORE THE EXPIRATION OF THE SIXTY-DAY PERIOD. THE FAILURE TO INCLUDE THIS NOTICE LANGUAGE ON THE FACE OF THE FORM SHALL RENDER THE FORM UNENFORCEABLE AND INVALID AS A WAIVER AND RELEASE UNDER SECTION 85-7-419, MISSISSIPPI CODE OF 1972.
Miss. Code § 85-7-433(1) · Official text · retrieved 2026-09-30

Waiver and release upon final payment

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framingandfigures-mississippi-waiver-final-payment.docx

WAIVER AND RELEASE UPON FINAL PAYMENT STATE OF MISSISSIPPI COUNTY OF __________ THE UNDERSIGNED MECHANIC AND/OR MATERIALMAN HAS BEEN EMPLOYED BY __________ (NAME OF CONTRACTOR) TO FURNISH __________ (DESCRIBE MATERIALS AND/OR LABOR) FOR THE CONSTRUCTION OF IMPROVEMENTS KNOWN AS __________ (TITLE OF THE PROJECT OR BUILDING) WHICH IS LOCATED IN THE CITY OF __________, COUNTY OF __________, AND IS OWNED BY __________ (NAME OF OWNER) AND MORE PARTICULARLY DESCRIBED AS FOLLOWS: (DESCRIBE THE PROPERTY UPON WHICH THE IMPROVEMENTS WERE MADE BY USING EITHER A METES AND BOUNDS DESCRIPTION, THE LAND LOT DISTRICT, BLOCK AND LOT NUMBER, OR STREET ADDRESS OF THE PROJECT.) UPON THE RECEIPT OF THE SUM OF $__________, THE MECHANIC AND/OR MATERIALMAN WAIVES AND RELEASES ANY AND ALL LIENS OR CLAIMS OF LIENS IT HAS UPON THE FOREGOING DESCRIBED PROPERTY OR ANY RIGHTS AGAINST ANY LABOR AND/OR MATERIAL BOND ON ACCOUNT OF LABOR OR MATERIALS, OR BOTH, FURNISHED BY THE UNDERSIGNED TO OR ON ACCOUNT OF SAID CONTRACTOR FOR SAID PROPERTY. SIGNATURE BY: __________ (PRINT NAME) ITS: __________ (PRINT TITLE) SWORN TO AND SUBSCRIBED BEFORE ME, THIS THE __________ DAY OF __________, 20__________. NOTARY PUBLIC NOTICE: WHEN YOU EXECUTE AND SUBMIT THIS DOCUMENT, YOU SHALL BE CONCLUSIVELY DEEMED TO HAVE BEEN PAID IN FULL THE AMOUNT STATED ABOVE, EVEN IF YOU HAVE NOT ACTUALLY RECEIVED THE PAYMENT, SIXTY (60) DAYS AFTER THE DATE STATED ABOVE UNLESS YOU FILE EITHER AN AFFIDAVIT OF NONPAYMENT OR A CLAIM OF LIEN BEFORE THE EXPIRATION OF THE SIXTY-DAY PERIOD. THE FAILURE TO INCLUDE THIS NOTICE LANGUAGE ON THE FACE OF THE FORM SHALL RENDER THE FORM UNENFORCEABLE AND INVALID AS A WAIVER AND RELEASE UNDER SECTION 85-7-419, MISSISSIPPI CODE OF 1972. SIGNATURE BY: __________ (PRINT NAME) ITS: __________ (PRINT TITLE) SWORN TO AND SUBSCRIBED BEFORE ME, THIS THE __________ DAY OF __________, 20__________. NOTARY PUBLIC
Miss. Code § 85-7-433(2) · Official text · retrieved 2026-09-30

Affidavit of nonpayment

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framingandfigures-mississippi-affidavit-of-nonpayment.docx

AFFIDAVIT OF NONPAYMENT STATE OF MISSISSIPPI COUNTY OF __________ THE UNDERSIGNED MECHANIC AND/OR MATERIALMAN HAS BEEN EMPLOYED BY __________ (NAME OF CONTRACTOR) TO FURNISH __________ (DESCRIBE MATERIALS AND/OR LABOR) FOR THE CONSTRUCTION OF IMPROVEMENTS KNOWN AS __________ (TITLE OF THE PROJECT OR BUILDING) WHICH IS LOCATED IN THE CITY OF __________, COUNTY OF __________, AND IS OWNED BY __________ (NAME OF OWNER) AND MORE PARTICULARLY DESCRIBED AS FOLLOWS: (DESCRIBE THE PROPERTY UPON WHICH THE IMPROVEMENTS WERE MADE BY USING EITHER A METES AND BOUNDS DESCRIPTION, THE LAND LOT DISTRICT, BLOCK AND LOT NUMBER, OR STREET ADDRESS OF THE PROJECT.) PURSUANT TO SECTION 85-7-419 THE UNDERSIGNED EXECUTED A LIEN WAIVER AND RELEASE WITH RESPECT TO THIS PROPERTY DATED __________, __________. THE AMOUNT SET FORTH IN THE WAIVER AND RELEASE ($__________) HAS NOT BEEN PAID, AND THE UNDERSIGNED HEREBY GIVES NOTICE OF THE NONPAYMENT. THE ABOVE FACTS ARE SWORN TRUE AND CORRECT BY THE UNDERSIGNED. SIGNATURE BY: __________ (PRINT NAME) ITS: __________ (PRINT TITLE) SWORN TO AND SUBSCRIBED BEFORE ME, THIS THE __________ DAY OF __________, 20__________. NOTARY PUBLIC WITHIN TWO (2) DAYS OF FILING THIS AFFIDAVIT OF NONPAYMENT, THE FILING PARTY SHALL SEND A COPY OF THE AFFIDAVIT BY REGISTERED OR CERTIFIED MAIL OR STATUTORY OVERNIGHT DELIVERY TO THE OWNER OF THE PROPERTY. WHENEVER THE OWNER OF THE PROPERTY IS AN ENTITY ON FILE WITH THE SECRETARY OF STATE’S OFFICE, SENDING A COPY OF THE AFFIDAVIT TO THE COMPANY’S ADDRESS OR THE REGISTERED AGENT’S ADDRESS ON FILE WITH THE SECRETARY OF STATE SHALL BE DEEMED SUFFICIENT.
Miss. Code § 85-7-433(3) · Official text · retrieved 2026-09-30

Who uses these forms

Mississippi's lien law prints three forms in Miss. Code § 85-7-433 [2]: the interim waiver and release upon payment in subsection (1), the waiver and release upon final payment in subsection (2), and the affidavit of nonpayment in subsection (3).

Both waiver forms are mandatory. Under § 85-7-419(2) and (3), a waiver and release a claimant is requested to execute in exchange for a payment, or to induce one, has to substantially follow the interim form for a payment other than final payment and the final form for final payment [2]. Each reaches liens on the described property and rights against any labor and/or material bond.

Under § 85-7-419(1), a right to claim a lien or upon a bond may not be waived in advance of furnishing labor, services or materials, and any purported waiver or release made that early is null, void and unenforceable [2].

What the statute says about them

An executed waiver and release binds the claimant for all purposes, subject only to payment in full of the amount it sets out [2]. Section 85-7-419(5)(b) then says the amount is conclusively deemed paid in full on the earliest of three events: actual receipt of funds; the claimant's execution of a separate written acknowledgment of payment in full; or 60 days [2] after the waiver and release is executed, unless before that period ends the claimant files an affidavit of nonpayment in the county where the property is located and sends a true and accurate copy to the owner in the manner § 85-7-405 provides for a notice of a claim of lien [2].

Filing that affidavit suspends the waiver and release until payment in full is received, except as § 85-7-413 provides [2].

Notarization is required. All three forms carry the same oath line, "SWORN TO AND SUBSCRIBED BEFORE ME", and a line for a notary public [2].

Reading the blanks

The three forms open alike, with blanks for the county, contractor, work furnished, project, owner and property.

The interim form adds a sum, a date through which the release runs, and an exception for rights and liens in retained amounts. The final form asks only for a sum. Both waiver forms print a NOTICE that the person who executes and submits the form is conclusively deemed paid in full the amount stated above, even without receiving the payment, "SIXTY (60) DAYS AFTER THE DATE STATED ABOVE UNLESS YOU FILE EITHER AN AFFIDAVIT OF NONPAYMENT OR A CLAIM OF LIEN BEFORE THE EXPIRATION OF THE SIXTY-DAY PERIOD" [2]. A blank completed incorrectly does not invalidate either waiver form if the subject matter of the release reasonably may be determined [2].

The affidavit of nonpayment gives the date of the waiver and release already executed and the amount in it, which it states has not been paid. Its closing paragraph has the filing party send the owner a copy within 2 days [2] of filing, by registered or certified mail or statutory overnight delivery.

Each form has lines for a signature, a printed name and title, the date and the notary. On the final payment form, that signature and notary block prints twice, before the NOTICE and after it.

What changed recently

Section 85-7-419 and the forms came from 2014 Senate Bill 2622 [1], Laws 2014, chapter 487, in force from its passage [2]. Section 85-7-433, which prints the forms, was amended by Laws 2015, chapter 348, effective July 1, 2015 [2].

Related

Lien waivers: other states

Sources

  1. Mississippi Senate Bill 2622 (2014), as sent to the Governor, Mississippi Legislature (retrieved 2026-09-29)
  2. Miss. Code Ann. §§ 85-7-419 and 85-7-433, Mississippi Code 1972 Annotated, LexisNexis public access for the Mississippi Legislature (retrieved 2026-09-30)

Changelog

  1. : Page published.
  2. : Georgia and Mississippi lien waiver forms from the codified text, retrieved 2026-09-30: 35 of 51 jurisdictions published.
  3. : Dataset first published: 33 of 51 jurisdictions published; 2 more verified and awaiting their codified text.