RD 1924-10 Release by Claimants

Form Approved
OMB No. 0575-0189
Exp. Date: 03/31/2026

USDA
Form RD 1924-10
(Rev. 1-98)

RELEASE BY CLAIMANTS
The undersigned, having received payment in full for all labor, materials, supplies, or equipment supplied to
or to any subcontractor, in the construction or repair of the improvements upon the property located at:

, Contractor,

, and furnished in the execution and fulfillment of contract between said Contractor and
Owner, dated
, do (does) hereby release and waive any and all claims,

liens, and lien rights, of any kind, nature, or description whatsoever, against said property and the Owner thereof, and against said
Contractor.
Lien or Claimant

Work or Materials

Amount

Date

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information
collection is 0575-0042 and 0575-0189, which expires 03/31/2026. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection information. All responses to this collection of information are voluntary. Any questions on this burden can be sent to ICRMTRequests@usda.gov.

POSITION 6

RD 1924-10 (Rev. 1-98)