Fill and Sign the Improvements of Real Property Located at and Legally Described as Form

Assignment of Lien Page 1 of 2 Prepared by, recording requested by and return to: Name: ___________________ Company: ____________________ Address: ______________________ City: ________________________ State: _____ Zip: _________ Phone: _____________________ Fax: _____________________ ----------------------Above this Line for Official Use Only--------------------- ASSIGNMENT OF LIEN- INDIVIDUAL Beginning on or about the _____ of _______________, 20_____, the undersigned lienor, __________________________________, furnished or supplied labor, materials, or laborers to ___________________________________ for the purpose of improvements of real property located at and legally described as _________________________________________________________________, such that the undersigned lienor is entitled to a lien for the value of labor, materials, or laborers supplied. The last date the undersigned performed work or furnished materials was the _____ day of ________________, 20_______. Notice is hereby given that the above-mentioned lienor does hereby assign his or her claim and lien in the amount of $ _______________ to ___________________________________, who shall hereafter have all the rights and remedies under law to which the lienor is entitled subject to all defenses thereto that might be made if such assignment had not been made, for the purpose of filing and for the enforcement of the above-mentioned lien. This the _____ day of _______________, 20______. __________________________________ Signature of Lien Holder__________________________________ Type or Print Name Witnessed or Attested by: ____________________________ Assignment of Lien Page 2 of 2 ____________________________ STATE OF SOUTH CAROLINA COUNTY OF _________________ The foregoing instrument was acknowledged before me this __________________ (date) by ____________________________________ (name of person acknowledged). ____________________________________ Notary Public Print Name: _________________________ My commission expires: _______________