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Fill and Sign the Discharge Lien Form Michigan

Fill and Sign the Discharge Lien Form Michigan

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Select the discharge of lien form and open it.
Fill out the form and add an eSignature.
Save the discharge of lien, print, or email it.

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Certificate of Discharge of Lien-Individual (M.S.A. § 570.1127) On this _____ day of _____________ , 20 ________ , the undersigned does hereby acknowledge receipt of payment from ___________________________________ in the amount of $ ______________ which represents payment in full for labor performed and materials furnished by _________________________________ in reference to the work on the following described property: ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ . By this document the undersigned lien claimant hereby releases any lien it may have in connection with the above - described property for labor performed and materials furnished. __________________________________ Signature _____ _____________________________ Type or Print Name __________________________________ Witness Witness STATE OF MICHIGAN COUNTY OF __________________ The foregoing instrument was acknowledged before me this the _____ day of ________________ , 20 ________ , by ___________________________________ (name). ______________________________ Notary Public, State of Michigan ______________________________ Printed Name Commission Expires: ______________ Certificate of Discharge of Lien Page 1 of 1

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