Fill and Sign the For Official Use Only Noaa Western Regional Center Form

Release of Lien Page 1 of 2 Prepared by, recording requested by and return to: ---------------------- Above this Line for Official Use Only --------------------- Name: Company: Address: City: State: Zip: Phone: Fax: RELEASE OF LIEN --CORPORATION (Kan. Stat. Ann. § 60 -1103b(d)) COMES NOW, __________________________________, as a representative of ___________________________ a __________________________ corporation which has provided labor and/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 filed a notice of intent to pro vide labor and/or materials for the construction of the above described new residential property. 2. Payment in full was made to the undersigned on the _____ day of ___________________, 20____. 3. The undersigned would hereby state that it is the inte ntion of the undersigned lien claimant to waive or relinquish any statutory right to a lien for the furnishing of labor or material to said property. This the ____ day of ____________________, 20____. ______________________________ Sig nature ______________________________ Title ______________________________ Corporation Release of Lien Page 2 of 2 Acknowledgment of Corporation STATE OF KANSAS COUNTY OF ___________________ This instrument was acknowle dged before me on __________________________ (date) by ___________________________________________ [name(s) of person(s)] as _____________________________________________________ (type of authority, e.g., officer, trustee, etc.) of _______________________ ______________ (name of party on behalf of whom instrument was executed.) _____________________________ Notary Public Print Name: ___________________ My commission expires: _____________________ KS § 60 -1103b(d)