Fill and Sign the Claim Lien Property Form

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 Claim of Lien on Real Property – Corporation (N.C. Gen. Stat. § 44A-12(e)) COMES NOW, ________________________________ , as a representative of _________________________________ a _________________________________ corporation who has provided labor 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 lien claimant, __________________________________ , of the following address _______________________________________________________________________ , filed a Notice of Claim of Lien regarding the above described property in the amount of $ _____________ . Assignment of Claim of Lien on Real Property Page 1 of 2 2. Said lien is hereby expressly assigned to __________________________________ , of the following mailing address, _______________________________________________________________________ . This the _____ day of ________________ , 20 ______ . __________________________________ Signature _____ _____________________________ Type or Print Name _____ _____________________________ Title _____ _____________________________ Corporation Attest: Secretary STATE OF NORTH CAROLINA COUNTY OF _____________________ I, a Notary Public, do hereby certify that _________________________________ (here give the name of the grantor or maker) personally appeared before me this day and acknowledged the due execution of the foregoing instrument. Witness my hand and (where an official seal is required by law) official seal This the ___________________ day of ___________________ (year). (Official seal.) ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________ Assignment of Claim of Lien on Real Property Page 2 of 2