Fill and Sign the Car Totaled but Title in Friends Name Us Insurance Agents Form

Release 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: RELEASE OF LIEN --INDIVIDUAL (Kan. Stat. Ann. § 60-1103b(e)) COMES NOW, __________________________________, as a party who has provided labor and/or materials for the improvement of the property located at and described as ________________________________________________________________________ _______________________________________________________________________, and would state as follows: 1. On or about the ____ day of ______________, 20____, the undersigned filed a notice of intent to provide labor and/or materials for the construction of the above described new residential property. 2. Payment in full was made to the undersigned on the _____ day of ___________________, 20____. 3. The undersigned would hereby state that it is the intention of the undersigned lien claimant to waive or relinquish any statutory right to a lien for the furnishing of labor or material to said property. This the ____ day of ____________________, 20____. ______________________________ Signature Release of Lien Page 2 of 2 Acknowledgment of Individual STATE OF KANSAS COUNTY OF ___________________ This instrument was acknowledged to me on _______________________________ (date) by ________________________________ [name(s) of person(s)]. ______________________________ Notary Public Print Name: ___________________ My commission expires: ___________________ KS § 60-1103b(d)