Fill and Sign the Nature of Document Cancellation of Form

Cancellation of Lien Page 1 of 2 Prepared by, recording requested by and return to: Name: __________________ Company: __________________ Address: _____________________ City: _______________ State: _____ Zip: __________ Phone: ________________ Fax: _________________ Nature of Document: Cancellation of Lien ----------------------Above this Line for Official Use Only--------------------- CANCELLATION OF LIEN-INDIVIDUAL COMES NOW, __________________________________, as a party claiming a lien on the property described as _______________________________________________________________________, and would state as follows: 1. The undersigned recorded a lien against the above described property, owned by __________________________________, on the _____ day of _______________, 20______, in the amount of $______________. 2. The undersigned hereby acknowledges that on or about the _____ day of _____________, 20______, the undersigned received a payment from _______________________________ in the amount of $______________. 3. Said amount represents payment in full for labor performed and/or materials furnished by the undersigned for the following described improvements and/or materials, _______________________________________________________________________________________________________________________________________________________________________________________________________________________. 4. By this document the undersigned lien claimant hereby cancels any lien he or she may have in connection with the above-described property for labor performed and materials furnished. This the _____ day of ________________, 20______. __________________________________ Signature of Lien Holder__________________________________ Type or Print Name Cancellation of Lien Page 2 of 2 Acknowledgment of Individual State of Utah County of __________________ On the ______ day of __________________, 20______, personally appeared before me ______________________________, the signer of the foregoing instrument, who duly acknowledged to me that he/she executed the same. (Seal) Notary Public My commission expires: Type or Print Name Residing at: