Fill and Sign the Certificate to Discharge Lien Claim of Recordindividualresidential 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—INDIVIDUAL- 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 Cl aimant 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______. Certificate to Discharge Lien Claim of Record Page 2 of 2Signed, sealed and deliveredin the Presence of or Attested by:____________________________ ____________________________ (Seal) Lien Claimant____________________________Type or Print Name ____________________________State of New JerseyCounty of _________________, ss: I CERTIFY that on ___________________, ______________ , __________________________________ personally came before me and acknowledged under oath to my satisfaction, that this person (or if more than one, each person): a) is named in and personally signed the attached document; andb) signed and delivered this document as his/her/their act and deed. _______________________________ Claimant______________________________Notary PublicPrint Name: ___________________ My commission expires:_______________NJ § 2A:44A-30