STATE OF State Where Release Signed

COUNTY OF County Where Release Signed

Name of Party Releasing the Lien, being duly sworn to tell the truth states that by virtue of Reason for Lien provided to Name of Party Against Whom Lien Was Filed, at Description of Job Liened, claimed a lien on the property of Name of the Owner of Property Liened.

Having received full satisfaction thereof, Name of Party Releasing the Lien consents to release of the lien.

Said lien having been recorded in Title of Book Where Recorded Book, Page Pages Where Recorded of the Records Where Recorded records of County Where Recorded County, State Where Recorded.


Name of Party Releasing the Lien

Sworn to and subscribed before me on Date.

Name of Officer

Title of Officer