Fill and Sign the North Carolina Satisfaction Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: Company: Address: City: State: Zip: Phone: Fax: Instrument of Satisfaction – Individual (N.C. Gen. Stat. § 44A-16(2)) COMES NOW, _______________________________, as the owner of the improved property located at and described as ________________________________________________________________________ _______________________________________________________________________, and would state as follows: 1. On the _____ day of _________________, 20_____ a lien statement was filed by _________________________________________, claiming a lien against the above described property in the amount of $____________________. Instrument of Satisfaction Page 1 of 3 2. The undersigned property owner and lien claimant hereby acknowledge the satisfaction of said lien indebtedness by payment in full on or about the ____ day of ______________, 20____. This the _____ day of ______________, 20____. ________________________________ Lien Claimant ________________________________ Property Owner Instrument of Satisfaction Page 2 of 3 Acknowledgment of Lien Claimant 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: _____________________ Instrument of Satisfaction Page 3 of 3