Fill and Sign the Dc Notice 497301526 Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: _______________________ Company: _____________________ Address: ____________________ City: _______________________ State: _____ Zip: ________ Phone: _______________________ Fax: _______________________ NOTICE OF SATISFACTION--INDIVIDUAL (DC §§ 40–303.15) COMES NOW _______________________ , and hereby provides notice of the following: 1. That on or about the ____ day of _________________ , 20 ____ , the undersigned filed a Notice of Claim attesting to a lien in the amount of $ __________________ . 2. Said lien amount represented the contract price, or in the absence of a contract the value of labor and/or materials supplied, for the erection, improvement, addition to, or repair of a building located at ____________________________________ and owned by ____________________________________ . 3. This notice hereby acknowledges the satisfaction of said lien, including all costs associated therewith. This the ____ day of _________________ , 20 ____ . ________________________ Signature District of Columbia This instrument was acknowledged before me on this ____ day of _________________ , 20 ____ , by ____________________________________ . ___________________________ (Signature of notarial officer) (Seal, if any) Title (and Rank) ___________________________ (My commission expires: ______________) Notice of Satisfaction Page 1 of 1