Fill and Sign the Illinois Release Lien Form

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 CLAIM--INDIVIDUAL STATE OF ILLINOIS COUNTY OF _______________ FOR THE PROTECTION OF THE OWNER, THIS RELEASE SHOULD BE FILED WITH THE RECORDER OR THE REGISTRAR OF TITLES IN WHOSE OFFICE THE CLAIM FOR LIEN WAS FILED. TO: Registrar of ____________ County The below named Claimant, located at _______________________________________ ____________________________________ (address of Claimant), hereby directs you to discharge and release of record the following lien: Claim of Lien filed on the ______ day of __________________, 20____, at Book ________, Page __________ in the amount of ____________________ dollars, for the value of work, services, material or equipment, in accordance with a contract between Claimant and ________________________________. The owner of the property upon which the lien was filed is ______________________________, said property being located in ________________ County, Illinois, and being described as follows: [Describe Property or Attach Exhibit] The claim has been paid/satisfied/settled by the parties/ forfeited by the claimant. Release of Lien Claim Page 1 of 2 This the _____ day of ___________________, 20____. __________________________ Signature STATE OF ILLINOIS COUNTY OF ________________ The foregoing instrument was acknowledged before me this _________ day of ________________, 20_________ by ____________________________________(name of person acknowledged.) ______________________________ Notary Public (SEAL) Printed Name: _________________ My Commission Expires: _____________________ (770 ILCS 60/35) Release of Lien Claim Page 2 of 2