State
County
This Lien Release is executed on by:
, an individual having their usual place of living at (the "Lienor").
I, as the Lienor, acknowledge receipt of the for provided to the , an individual having their usual place of living at for:
In consideration thereof, all provided by the Lienor for the Project have been fully compensated, and the Lienor hereby releases the lien, which was recorded in the of County, State of , book number , on .
Signature: ___________________
NOTARY ACKNOWLEDGMENT
State of
Acting in the county of
Sworn to and subscribed before me on ___________________________.
___________________________________
Place for signature
______________________________________
Notary public's name and seal