Fill and Sign the North Carolina Mechanics Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: Company: Address: City: State: Zip: Phone: Fax: Acknowledgement of Satisfaction – Individual (N.C. Gen. Stat. § 44A-16) COMES NOW, _______________________________, as a party who has provided labor and/or materials for the improvement of the property located at and described as ________________________________________________________________________ _______________________________________________________________________, and would state as follows: 1. On the _____ day of _________________, 20_____ the undersigned recorded a lien statement claiming a lien in the amount of $____________________. Acknowledgement of Satisfaction Page 1 of 3 2. The undersigned lien claimant hereby acknowledges the satisfaction of said lien indebtedness by payment in full on or about the ____ day of ______________, 20____. This the _____ day of ______________, 20____. ________________________________ Lien Claimant ________________________________ Clerk of the Superior Court Acknowledgement of Satisfaction Page 2 of 3 Acknowledgment of Individual STATE OF NORTH CAROLINA COUNTY OF _____________________ I, a Notary Public, do hereby certify that _________________________________ (here give the name of the grantor or maker) personally appeared before me this day and acknowledged the due execution of the foregoing instrument. Witness my hand and (where an official seal is required by law) official seal This the ___________________ day of ___________________ (year). (Official seal.) ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________ Acknowledgement of Satisfaction Page 3 of 3