Fill and Sign the Certificate to Discharge Lien Claim of Record Form

Certificate to Discharge Lien Claim of Record Page 1 of 2Prepared by, recording requested by and return to:Name: _________________Company: __________________Address: ____________________City: ___________________State: _____Zip: __________Phone: _______________Fax: ________________ ----------------------Above this Line for Official Use Only--------------------- CERTIFICATE TO DISCHARGE LIEN CLAIM OF RECORD — CORPORATION- RESIDENTIAL TO:Clerk of _________________ CountyThe below named Claimant, located at ________________________________________________________________________ (address of Claimant), hereby directs you to discharge of record the following lien:Lien Claim filed on the _____ day of ________________, 20______, at Book ________, Page _______ in the amount of ____________________ dollars, for the value of work, services, material or equipment, in accordance with a contract between Claimant and _________________________________. The owner of the property upon which the lien was filed is __________________________________, said property being located in ________________ County, New Jersey, and being described as follows:________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________[Describe Property or Attach Exhibit]The written contract is a residential construction contract as defined in section 2 of this act. The claim has been paid/satisfied/settled by the parties/ forfeited by the claimant.This the _____ day of _____________ , 20______.Signed, sealed and deliveredIn the presence of or attested by:_______________________________ Certificate to Discharge Lien Claim of Record Page 2 of 2 Corporation ___________________________ ________________________By ________________________ Type or Print Name ________________________ Title State of New JerseyCounty of ________________, ss: I CERTIFY that on _________________, ____________ , ___________________________________ personally came before me and this person acknowledged under oath, to my satisfaction, that: (a) this person is the ___________________ of the corporation named in this document; (b) this document was signed and delivered by the corporation as its voluntary act duly authorized by a proper resolution of its Board of Directors;(c) this person knows the proper seal of the corporation which was affixed to this document; and (d) this person signed this proof to attest to the truth of these facts. __________________________________ Name:Title: ____________________________ Signed and sworn to before me on _______________ , __________. ______________________________Notary PublicPrint Name: ___________________ My commission expires:________________NJ § 2A:44A-30