Fill and Sign the Notice of Satisfaction of Lien Individual Form

Notice of Satisfaction of Lien Page 1 of 2 Prepared by, recording requested by and return to: Name: _____________________ Company: ___________________ Address: _____________________ City: _____________________ State: _____ Zip: __________ Phone: ________________ Fax: _________________ ----------------------Above this Line for Official Use Only--------------------- NOTICE OF SATISFACTION OF LIEN--INDIVIDUAL ( M.A.S. § 429.120) On this the _____ day of _______________, 20______, the undersigned does hereby acknowledge receipt of payment from __________________________________ in the amount of $______________ which represents payment in full for labor performed and/or materials furnished by _________________________________ for the following improvements ________________________________________________________________________________________________________________________________________________________________________________________________________________________ to the property located at: _______________________________________________________________________. By this document the undersigned lien claimant hereby releases any lien it may have in connection with the above-described property for labor performed and materials furnished. __________________________________ Signature of Lien Holder__________________________________ Type or Print Name STATE OF MISSOURI COUNTY OF _______________ On this _____ day of ________________, 20______, before me personally appeared __________________________________, to me known to be the person described in and who executed the foregoing instrument, and acknowledged that he/she executed the same as his/her free act and deed. Notice of Satisfaction of Lien Page 2 of 2 IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my official seal in the county and state aforesaid, the day and year first above written. ______________________________ Notary Public My commission expires: ________________