Fill and Sign the Beginning on or About the of 20 Form

Assignment of Lien Page 1 of 2 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 - CORPORATION Kan. Stat. Ann. § 60 -1104 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 improveme nts 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 pursuant to Kan. Stat. Ann § 60 -1104 the above - mentioned lien claimant does hereby assign the undersigned’s claim and lien to ___________________________________ , who sha ll hereafter have all the rights and remedies under law to which the lien claimant is entitled , subject to all defenses thereto that might be made if such assignment had not been made , for the purpose of filing a nd for the enforcement of the above -mentioned lien. This the _____ day of _______________ , 20 ______ . ______________________________ Signature _____ _________________________ Type or Print Name _____ _________________________ Title _____ _________________________ Corporation Attest: Secretary Assignment of Lien Page 2 of 2 Acknowledgment of Corporation STATE OF KANSAS COUNTY OF ___________________ This instrument was acknowledged before me on __________________________ (date) by ___________________________________________ [name(s) of person(s)] as _____________________________________________________ (type of authority, e.g., officer, trustee, etc. ) of _____________________________________ (name of party on behalf of whom instrument was executed.) _____________________________ Notary Public _____________________________ Type or Print Name ______________________________ Title (and Rank) (Sea l, if any) My appointment expires: _____________________ KS § 60 -1104