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Fill and Sign the Affidavit in Support of Cancellation of Preliminary Lien After Notice to File Claim of Lien Individual Georgia Form

Fill and Sign the Affidavit in Support of Cancellation of Preliminary Lien After Notice to File Claim of Lien Individual Georgia Form

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Prepared by, recording requested by and return to: Name _____________________________ Street __________________________ Address ____________________________ City _________________________ State ______________ Zip ____________________ Phone __________________________ ------------------------------------Above this line for Official Use Only ----------------------------------- AFFIDAVIT FOR CANCELLATION OF PRELIMINARY LIEN NOTICE- INDIVIDUAL STATE OF GEORGIA COUNTY OF ______________________ BE IT KNOWN THAT _________________________________ , upon being duly sworn, states on his or her oath the following: 1. I filed a demand for filing of a claim of lien to __________________________________ , in connection with the Preliminary Lien Notice filed by __________________________ . The demand was filed in accordance with 44 - 14 - 361.4(a) (3) or (4). The demand was mailed by registered or certified mail or statutory overnight delivery on _____ day of _________________ , 20 ______ . 2. A true and correct copy of the Demand to File a Claim of Lien is attached hereto as Exhibit "A" and incorporated herein by reference. 3. Ten (10) days has elapsed since the date of mailing of the Demand to file a Claim of Lien without the filing of a claim of lien by the potential lien claimant. 4. The Clerk of Superior Court is therefore requested to cancel of record the preliminary notice of lien rights filed by ___________________________________ . WITNESS my signature this the _____ day of __________________ , 20 _____ . __________________________________________ Signature Printed Name: _____ _________________________ Sworn to and executed in the presence of: _______________________ (Witness) Affidavit for Cancellation of Preliminary Lien Notice Page 1 of 2 Sworn to (or affirmed) and subscribed before me this ____ day of __________ (month), __________ (year), by _______________________ (name of person making statement). _______ Personally Known _______ Produced Identification Type and # of ID __________________________ ____________________________ (Signature of Notary) (Seal) _____________________________ (Name of Notary Typed, Stamped or Printed) Notary Public, State of Georgia My Commission Expires: ______________ Reference 44 - 14 - 361.4. Affidavit for Cancellation of Preliminary Lien Notice Page 2 of 2

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