Lienholder Removal Request

LIENHOLDER REMOVAL REQUEST AND RELEASE AGREEMENT

Client Name:

RECITALS

WHEREAS, Lienholder Name: recorded a lien or security interest affecting the Property/Asset described below on or about in the public records of ;

WHEREAS, Requestor represents that the obligation secured by the lien has been satisfied, released, extinguished, or otherwise resolved as described below and requests that the lien be released of record or otherwise removed; and

WHEREAS, Lienholder is willing to execute and deliver a formal release, satisfaction, or other document necessary to remove the lien from the public record upon the conditions set forth in this Request and Release Agreement.

LIEN AND ASSET INFORMATION

REQUEST FOR RELEASE / REASON FOR REMOVAL

I request removal of the lien recorded by the above-named Lienholder for the following reason(s):

Paid in full and satisfied   Released by court order   Recorded in error / administrative correction

SCOPE OF WORK

PAYMENT TERMS

Amount to be paid to Lienholder for processing release (if applicable): $

Late fee for overdue payment:

TERM AND TERMINATION

Effective Date: . Completion Date (if any):

Either party may terminate this Agreement for material breach by the other party if such breach remains uncured for the notice period specified above. Termination shall not relieve the Requestor of liability for sums due for services performed or costs incurred prior to termination.

CONFIDENTIALITY

The parties acknowledge that information exchanged under this Request and Release Agreement may include non-public financial, legal and transactional information. Each party agrees to maintain the confidentiality of such information and not to disclose it except as required by law, court order, or to governmental authorities, or with the other party's written consent. Confidential information does not include information that is or becomes generally available to the public other than through a breach of this Agreement.

RELEASE AND REPRESENTATIONS

Upon receipt of any payment and verification required by this Agreement, Lienholder shall execute and deliver a full release or satisfaction of lien in recordable form. Requestor represents and warrants that the statements in this Request are true and correct to the best of Requestor's knowledge, and that Requestor has the authority to request removal of the lien for the asset identified above.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to conflict of law principles. Venue for any dispute arising out of this Agreement shall lie in the courts of that state.

ENTIRE AGREEMENT

This Request and Release Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, representations, and understandings, whether written or oral. No amendment or modification of this Agreement shall be effective unless in writing and signed by both parties.

AUTHORIZATION AND CERTIFICATION

By signing below, Requestor certifies under penalty of perjury that the information provided on this form is true and correct, that any payment or documents provided are genuine, and that Requestor is authorized to request removal of the lien. Lienholder certifies that, subject to receipt and clearance of any payment required and verification of supporting documentation, Lienholder will promptly execute and record or deliver an instrument releasing or satisfying the recorded lien.

Requests, notices, and payments under this Agreement shall be delivered to the contact information provided above or to the following addresses for Lienholder and Requestor as applicable:

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