BROKER'S LIEN WAIVER
The undersigned, ____________________________ hereinafter referred to as “Broker” hereby acknowledges receipt of the sum of $_____________, representing the entire balance due to Broker for all services rendered by Broker relating to the sale, purchaser, or other conveyance of the following described Property:
[Insert legal description]
Commonly known as: [Insert address]
2. Broker hereby waives any claim or lien in which Broker may have against Purchaser, Seller or the Property by reason of the referenced transaction. Broker shall and does hereby indemnify and hold harmless Seller, Purchaser and ___________________________[insert name of title company and title insurer] from and against any such claim or lien which may be asserted by broker by reason of any fee or commission owed to broker under written agreement as provided for by I.C. 32-28-12.5.
3. Broker hereby warrants that the Broker is unaware of any other Brokers involved with the above-referenced transaction except:_______________________________________.
4. Broker hereby warrants that the undersigned has personal knowledge of the matters herein stated and is authorized and fully qualified to execute this instrument as or on behalf of Broker.
Subscribed and sworn to before me on the ___________________day of ________________.
__________________________________
[Printed Name of Broker]
STATE OF INDIANA )
) SS:
COUNTY OF ____________ )
Before me, a Notary Public in and for said County and State, personally appeared, _________________________________________________, who acknowledged the execution of the foregoing Warranty Deed, and who, having been duly sworn, stated that any representations therein contained are true.
WITNESS MY HAND and Notarial Seal this _________ day of ____________, 200_.
My commission expires:
_____________________ __________________________________________
Signature
__________________________________________
Printed, Notary Public
Resident of ____________ County,
State of________ _____________ .
No guidelines are available for this form at this time.