Fill and Sign the Or Her Claim and Lien to Who Shall Hereafter Form

Assignment 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--------------------- ASSIGNMENT OF LIEN- INDIVIDUAL Beginning on or about the _____ of _______________, 20_____, the undersigned lienor, __________________________________, furnished or supplied labor, materials, or laborers to ___________________________________ for the purpose of improvements of real property at _________________________________________________________________, such that the undersigned lienor is entitled to a lien for the value of labor, materials, or laborers supplied. Notice is hereby given that the above-mentioned lienor does hereby assign his or her claim and lien to ___________________________________, who shall hereafter have all the rights and remedies under law to which the lienor is entitled subject to all defenses thereto that might be made if such assignment had not been made, for the purpose of filing and for the enforcement of the above-mentioned lien. This the _____ day of _______________, 20______. __________________________________ Signature of Lien Holder__________________________________ Type or Print Name Assignment of Lien Page 2 of 2 STATE OF RHODE ISLAND COUNTY OF __________________ In ____________________________________ in said county on the _____ day of __________________, 20______, before me personally appeared __________________________________ each and all to me known and known by me to be the party(ies) executing the foregoing instrument, and ____________________________________ acknowledged said instrument, by ___________________________________ executed to be ___________________________________ free act and deed. ______________________________ NOTARY PUBLIC Print Name: ___________________ My Commission Expires: ___________________