Fill and Sign the Indiana Lien 497306842 Form

Partial 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 for ________________________________________________________________________ (descri be the specific labor performed and/or materials furnished) by __________________________________ for the following improvements:       to the property located at: Street Address: ________________________________________________ Legal Description:       Partial Discharge of Lien – Corporation Page 1 of 3 This document is a discharge of _________________________________ , a portion of the mechanic’s lien which the lien claimant has in connection with the above - described property for the labor performed and materials furnished. Signature       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       Partial Discharge of Lien – Corporation Page 2 of 3 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       Print or Type Name Signature       Print or Type Name Partial Discharge of Lien – Corporation Page 3 of 3