Fill and Sign the Assignment of Lien Individual Vermont Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ___________________ Company: ____________________ Address: ______________________ City: ________________________ State: _____ Zip: _________ Phone: _____________________ Fax: _____________________ ASSIGNMENT OF LIEN- INDIVIDUAL Beginning on or about the _____ of _______________ , 20 _____ , the undersigned lienor, __________________________________ , furnished or supplied labor, materials, or laborers to ___________________________________ for the purpose of improvements of real property at _________________________________________________________________ , such that the undersigned lienor is entitled to a lien for the value of labor, materials, or laborers supplied. Notice is hereby given that the above-mentioned lienor does hereby assign his or her claim and lien to ___________________________________ , who shall hereafter have all the rights and remedies under law to which the lienor is entitled subject to all defenses thereto that might be made if such assignment had not been made, for the purpose of filing and for the enforcement of the above-mentioned lien. This the _____ day of _______________ , 20 ______ . __________________________________ Signature of Lien Holder _____ _____________________________ Type or Print Name Assignment of Lien Page 1 of 2 STATE OF VERMONT COUNTY OF _________________ On this _____ day of _______________ , ___________ , before me personally appeared ___________________________________ (name of person acknowledging) to me known to be the person who executed the foregoing instrument, and ____________________________________ he/she/they thereupon duly acknowledged to me that ___________________________________ he/she/they executed the same to be ___________________________________ his/her/their free act and deed. ______________________________ Notary Public Print Name: ___________________ My commission expires: __________________ Assignment of Lien Page 2 of 2