Fill and Sign the Missouri Mechanic Lien Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ________________________ Company: _____________________ Address: ______________________ City: ___________________ State: _____ Zip: __________ Phone: _______________ Fax: ________________ PARTIAL RELEASE OF MECHANIC'S LIEN- MULTIPLE LOTS, TRACTS OR PARCELS —INDIVIDUAL (M.A.S. § 429.032(2)). STATE OF MISSOURI COUNTY OF ________________ COMES NOW __________________________________ , (name of lien claimant) the lien claimant and does hereby partially release its mechanic's lien filed on ________________________________ , (date lien filed) and filed for record as lien number __________________________________ (lien number or book and page numbers) The amount of the original mechanic's lien debt is $ ______________ . The amount of the original mechanic's lien debt which is now satisfied is $ ______________ . The lots, tracts or parcels which are being released are more fully described as follows: [Legal description of lots, tracts or parcels which are being released] ________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _______________________________________________ . ______________________________ Lien Claimant By ___________________________ (Signature of authorized representative) Partial Release of Mechanic’s Lien Page 1 of 2 _____ _________________________ Type or Print Name STATE OF MISSOURI COUNTY OF _______________ On this _____ day of ____________ , 20 _____ , before me personally appeared _________________________________ , to me known to be the person described in and who executed the foregoing instrument, and acknowledged that he/she executed the same as his/her free act and deed. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my official seal in the county and state aforesaid, the day and year first above written. ______________________________ Notary Public My commission expires: ________________ MO § 429.032(2) Partial Release of Mechanic’s Lien Page 2 of 2