Fill and Sign the New Jersey Lien 497319173 Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: _________________ Company: __________________ Address: ____________________ City: ___________________ State: _____ Zip: __________ Phone: _______________ Fax: ________________ CERTIFICATE TO DISCHARGE LIEN CLAIM OF RECORD--CORPORATION TO: Clerk of _________________ County The below named Claimant, located at ________________________________________________________________________ (address of Claimant), hereby directs you to discharge of record the following lien: Lien Claim filed on the _____ day of ________________ , 20 ______ , at Book ________ , Page _______ in the amount of ____________________ dollars, for the value of work, services, material or equipment, in accordance with a contract between Claimant and _________________________________ . The owner of the property upon which the lien was filed is __________________________________ , said property being located in ________________ County, New Jersey, and being described as follows: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ [Describe Property or Attach Exhibit] The claim has been paid/satisfied/settled by the parties/ forfeited by the claimant. This the _____ day of _____________ , 20 ______ . Signed, sealed and delivered In the presence of or attested by: _______________________________ Corporation ___________________________ ________________________ By Certificate to Discharge Lien Claim of Record Page 1 of 2 _____ ___________________ Type or Print Name _____ ___________________ Title State of New Jersey County of ______________ , ss: I CERTIFY that on __________________ , ___________ , ___________________________________ personally came before me and this person acknowledged under oath, to my satisfaction, that: (a) this person is the _______________________ of the corporation named in this document; (b) this document was signed and delivered by the corporation as its voluntary act duly authorized by a proper resolution of its Board of Directors; (c) this person knows the proper seal of the corporation which was affixed to this document; and (d) this person signed this proof to attest to the truth of these facts. __________________________________ Name: Title: ____________________________ Signed and sworn to before me on _______________________, ___________. ______________________________ Notary Public Print Name: ___________________ My commission expires: ____________________ NJ § 2A:44A-30 Certificate to Discharge Lien Claim of Record Page 2 of 2