Fill and Sign the Demand for Discharge of Lien Individual Indiana Form

Demand for Discharge of Lien-Individual (I.C.A. § 32-28-1-2; § 32-28-6-1) On this _____ day of ________________ , 20 ______ , the undersigned does hereby demand that you, as the owner, holder or custodian of a lien for labor performed or materials furnished in connection with improvements to the property located at: _______________________________________________________________________ , release, discharge and satisfy of record the mechanic’s lien no later than fifteen (15) days after the date you receive this written demand. If you fail, neglect or refuse to release, discharge and satisfy of record the mechanic’s lien not later than fifteen (15) days after receipt of this demand, you may be liable to the undersigned for t he greater of actual damages or liquidated damages in the sum of ten dollars ($10) per day from the fifteenth day until the release or expiration of the lien, the sum not to exceed five hundred dollars ($500), as well as costs and reasonable attorney's fees incurred in enforcing the release, discharge, or satisfaction of record of the lien. __________________________________ Signature _____ _____________________________ Type or Print Name STATE OF INDIANA ,       County, ss: Before me, the undersigned, a Notary Public in and for said County and State, personally appeared the within named       , who acknowledged the execution of the foregoing __________________ and who, being duly sworn, stated that the representations therein contained are true. Witness my hand and       Seal this       day of       , 20       . Notary Public. Resident of       County. My Commission expires       , 20       Demand for Discharge of Lien – Individual Page 1 of 2 Certificate of Delivery I,       , hereby certify that I have delivered this day a true and correct copy of the foregoing to       by: Registered Mail Mailing a true and correct copy of same by certified U.S. mail, postage prepaid, return receipt requested to       , the owner, holder or custodian located at       . So certified this the       day of       , 20       . Signature       Type or Print Name Demand for Discharge of Lien – Individual Page 2 of 2