Fill and Sign the Indiana Discharge Form

Discharge of Lien- Corporation (I.C.A. § 32-28-1-1) On this ______ day of ______________ , 20 ______ , the undersigned, as representative of __________________________ a ______________________________ corporation , does hereby acknowledge receipt of payment from ______________________________ in the amount of $ ________________ which represents payment in full for labor performed and/or materials furnished by ______________________________ for the following improvements       to the property located at: Street Address: ________________________________________________ Legal Description:       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       Discharge of Lien Page 1 of 3 Type or Print Name       Title       Corporation 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 __________________ for and on behalf of said ________________________ , a corporation , 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       This Instrument was prepared by:                   Affirmation Statement I affirm, under the penalties for perjury, that I have taken reasonable care to redact each Social Security number in this document, unless required by law. Signature Signature Discharge of Lien Page 2 of 3       Print or Type Name       Print or Type Name Discharge of Lien Page 3 of 3