Fill and Sign the Acknowledgement of Satisfacton of Lien Corporation 490218003 Form

Acknowledgement of Satisfaction of Lien Page 1 of 2 Prepared by, recording requested by and return to: Name: __________________ Company: ____________________ Address: _____________________ City: _________________ State: _____ Zip: _________ Phone: __________________ Fax: _________________ ----------------------Above this Line for Official Use Only--------------------- ACKNOWLEDGEMENT OF SATISFACTON OF LIEN – CORPORATION (S.D. Codified Laws Ann. §44-9-21) COMES NOW, _________________________________, as a representative of __________________________________ a _________________________________ corporation claiming a lien on the property described as _____________________________________________________________________, and would state as follows: 1. The undersigned recorded a lien against the above described property, owned by _________________________________, on the _____ day of _______________, 20______, in the amount of $_____________. 2. The undersigned hereby acknowledges that on or about the _____ day of ______________, 20______, the undersigned received a payment from __________________________________ in the amount of $____________. 3. Said amount represents payment in full for labor performed and/or materials furnished by the undersigned for the following described improvements and/or materials: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________. 4. By this document the undersigned lien claimant hereby releases any lien the undersigned may have in connection with the above-described property for labor performed and materials furnished and acknowledges the satisfaction thereof. This the _____ day of ______________, 20______. Acknowledgement of Satisfaction of Lien Page 2 of 2 __________________________________ Signature of Lien Holder__________________________________ Type or Print Name__________________________________ Title__________________________________ Corporation __________________________________ ___________________________________ Witness Witness Attest: Secretary State of South Dakota County of __________________ On this , the ______ day of ____________ , 20______ , before me, ______________________________ , the undersigned officer, personally appeared ______________________________ , who acknowledged himself to be the ____________ of ________________________ , a corporation, and that he/she, as such ________________________ being authorized so to do, executed the foregoing instrument for the purposes therein contained, by signing the name of the corporation by himself/herself as __________________. In witness whereof I hereunto set my hand and official seal. Notary Public, State of ____________ My commission expires: Type or Print Name