Fill and Sign the Lien Void Form

Prepared by, recording requested by and return to: Name __________________________ Company ________________________ Address ____________________________ City ________________________________ State ________ Zip ______________ Phone ____________________ ------------------------------------Above this line for Official Use Only ----------------------------------- REQUEST THAT CLERK MARK LIEN VOID OF RECORD - CORPORATION TO: Clerk, Superior Court of ________________ County, Georgia The undersigned _________________________________________ , as the owner of real property being improved and described as _____________________________________ hereby requests that the lien filed on the property located at ________________________________________________________ be marked void of record and states the following: 1. As certified in the attached affidavit, no Notice of Action has been filed with the clerk of the superior court as required by O.C.G.A. Section 44- 14-361.1 within 14 months from the time the claim became due. 2. I f the lien claimant, however, files a written objection within 30 days from the date of the filing of this request with the superior court clerk on the basis that the proper notice was timely filed, the clerk shall not mark the lien void and the parties may seek relief in the superior court through a declaratory judgment action. 3. If the lien claimant does not file an objection within 30 days after the filing of the request, the superior court clerk is directed, upon subsequent request of the undersigned owner of the real property, to release any bond filed and to mark the lien void of record by writing or marking on said lien the following language: "This lien is void of record pursuant to Code Section 44-14-367 of the Official Code of Georgia Annotated." 4. The undersigned shall file a copy with the superior court clerk at the time the request is filed of the return receipt showing that the lien claimant has received a copy of this request. This _____ day of __________________ , ___________ . Request that Clerk Mark Lien Void of Record Page 1 of 4 _________________________________ Signature of Owner _____ ____________________________ Type or Print Name _____ ____________________________ Title _____ ____________________________ Name of Corporation Attest: Secretary Affidavit of Service State of ________________ County of ____________________ I, ________________________________ , hereby certify that I have this date sent a true and correct copy of this ______________________________________ by certified mail, return receipt requested, registered mail, return receipt requested, statutory overnight delivery, acknowledging delivery signed by addressee or agent of addressee requested, in accordance with law, to the address specified in the original filing for record of his or her claim of lien prior to filing the request, which the name and address are as follows: __________________________________ __________________________________ __________________________________ __________________________________ (or if the lien claimant is no longer at the address specified in his or her original claim of lien and cannot be reasonably located, by an affidavit so stating in lieu of a return receipt). DATED this the ______ day of __________________ , 20 ______ . _____________________________ Signature _____ ________________________ Type or Print Name Request that Clerk Mark Lien Void of Record Page 2 of 4 Affidavit Certifying No Filing of Notice of Action STATE OF GEORGIA COUNTY OF ______________________ BE IT KNOWN THAT _________________________________ , an attorney licensed to practice law in Georgia, upon being duly sworn, states on oath the following: 1. The undersigned attorney has searched the superior court records in the county in which the subject property is located. 2. According to information received from the superior court clerk's office the indexes of real property transactions are current through a date more than 12 months from the date the lien claimant's claim became due. 3. The superior court records do not reflect that a Notice of Action has been filed as is required by O.C.G.A. Section 44-14-361.1. WITNESS my signature this the _____ day of __________________ , 20 _____ . __________________________________________ Signature Printed Name: _________________________ Sworn to (or affirmed) and subscribed before me this ____ day of __________ (month), __________ (year), by _______________________ (name of person making statement). _______ Personally Known _______ Produced Identification Type and # of ID __________________________ ____________________________ (Signature of Notary) (Seal) _____________________________ (Name of Notary Typed, Stamped or Printed) Notary Public, State of Georgia My Commission Expires: ______________ Reference: Request that Clerk Mark Lien Void of Record Page 3 of 4 44 - 14 - 367. Request that Clerk Mark Lien Void of Record Page 4 of 4