Fill and Sign the As a Representative of a Form

Assignment 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--------------------- ASSIGNMENT OF LIEN- CORPORATION Beginning on or about the _____ of _______________, 20_____, the undersigned as a representative of _________________________________ a _________________________________ corporate lien claimant, furnished or supplied labor, materials, or laborers to ___________________________________ for the purpose of improvements of real property at _________________________________________________________________, such that the undersigned lien claimant is entitled to a lien for the value of labor, materials, or laborers supplied. Notice is hereby given that the above-mentioned lien claimant does hereby assign the lien claimant’s claim and lien to ___________________________________, who may commence and prosecute the action upon all of the notices of lien in his or her own name or in the name of the original lien claimant. This the _____ day of _______________, 20______. ______________________________ Signature______________________________ Type or Print Name______________________________ Title ______________________________ Corporation Attest: Secretary Assignment of Lien Page 2 of 2 State of Nevada County of ________________ This instrument was acknowledged before me on _____________ by ___________________________________ as (type of authority, e.g., officer, trustee, etc.) __________________________________ of (name of party on behalf of whom instrument was executed) __________________________________. ___________________________ (Signature of notarial officer) (Seal, if any) ___________________________ (Title and rank (optional)) (My commission expires (optional): _____________)