STATE OF Enter state where this document is being executed)

COUNTY OF Enter county where this document is being executed)

Enter the name of the lien holder, referred to as HOLDER, is the owner/claimant of that certain The instrument being satisfied is, acknowledges payment in full of the same, which was recorded at Enter title of book where instrument recorded Book, Book Enter book number where instrument was recorded, page Enter page where instrument was recorded of the County, State of Enter state where this document is being executed, and consents to the release of the property from the lien and satisfaction of the The instrument being satisfied is on the record.

Dated: ________________________

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Enter the name of the lien holder

Enter the name of the lien holder, having being duly sworn to tell the truth, acknowledges the execution of this release of The instrument being satisfied is for the purposes stated herein.

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Officer

My commission expires: ___________________