Fill and Sign the Name of Officer or Agent Title of Officer or Form

Prepared by, recording requested by and return to: Name: ___________________ Company: ____________________ Address: ______________________ City: ________________________ State: _____ Zip: _________ Phone: _____________________ Fax: _____________________ ----------------------Above this Line for Official Use Only--------------------- ASSIGNMENT OF LIEN- CORPORATION Beginning on or about the _____ of _______________, 20_____, __________________________________, the undersigned, as a representative of _________________________________ a _________________________________ corporate lienor, furnished or supplied labor, materials, or laborers to ___________________________________ for the purpose of improvements of real property at _________________________________________________________________, such that the undersigned lienor is entitled to a lien for the value of labor, materials, or laborers supplied. Notice is hereby given that the above-mentioned lienor does hereby assign its claim and lien to ___________________________________, who shall hereafter have all the rights and remedies under law to which the lienor is entitled subject to all defenses 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 __________________________________ Title__________________________________ Corporation Attest: Secretary This instrument was prepared by _______________. STATE OF WEST VIRGINIA COUNTY OF ___________________ This instrument was acknowledged before me on ________________ (date) by _________________________________ (name of officer or agent, title of officer or agent) of _________________________________ (name of corporation acknowledging) a ________________________ corporation (state or place of incorporation) on behalf of the corporation. ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _________________