Fill and Sign the Cancellation of Lien by Individual Utah Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: __________________ Company: __________________ Address: _____________________ City: _______________ State: _____ Zip: __________ Phone: ________________ Fax: _________________ Nature of Document: Cancellation of Lien CANCELLATION OF LIEN-INDIVIDUAL COMES NOW, __________________________________ , as a party 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 cancels any lien he or she may have in connection with the above - described property for labor performed and materials furnished. This the _____ day of ________________ , 20 ______ . __________________________________ Signature of Lien Holder _____ _____________________________ Type or Print Name Cancellation of Lien Page 1 of 2 Acknowledgment of Individual State of Utah County of __________________ On the ______ day of __________________ , 20 ______ , personally appeared before me ______________________________ , the signer of the foregoing instrument, who duly acknowledged to me that he/she executed the same. (Seal) Notary Public My commission expires:             Type or Print Name Residing at:       Cancellation of Lien Page 2 of 2