Fill and Sign the Kansas Lien Form

Assignment 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: _____________________ ASSIGNMENT OF LIEN- INDIVIDUAL Kan. Stat. Ann. §60-1104 Beginning on or about the _____ of _______________, 20_____, the undersigned lien claimant, __________________________________, furnished or supplied labor, materials, or laborers to ___________________________________ for the purpose of improvements of real property at _________________________________________________________________, such that the undersigned lien claimant is entitled to a lien for the value of labor, mate rials, or laborers supplied. Notice is hereby given that pursuant to Kan. Stat. Ann § 60-1104 the above- mentioned lien claimant does hereby assign his or her claim and lien to ___________________________________, who shall hereafter have all the rights and remedies under law to which the lien claimant is entitled, subject to all defe nses 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 ______________________________ Type or Print Name Assignment of Lien Page 2 of 2 Acknowledgment of Individual STATE OF KANSAS COUNTY OF ___________________ This instrument was acknowledged to me on _______________________________ (date) by ________________________________ [name(s) of person(s)]. ______________________________ Notary Public ______________________________ Type or Print Name ______________________________ Title (and Rank) (Seal, if any) My appointment expires: ___________________ KS § 60-1104