Fill and Sign the Property Described as and Located at Form

Assignment of Lien Page 1 of 2Prepared by, recording requested by and return to:Name: ___________________Company: ____________________Address: ______________________City: ________________________State: _____Zip: _________Phone: _____________________Fax: _____________________UPI Number: ________________----------------------Above this Line for Official Use Only--------------------- ASSIGNMENT OF LIEN- CORPORATION Beginning on or about the _____ of _______________, 20_____, __________________________________, the undersigned, as a representative of _________________________________ a _________________________________ corporate lienor, furnished or supplied labor, materials, or laborers to ___________________________________ for the purpose of improvements of real property described as and located at _________________________________________________________________ (address should include municipality, ward (if in the city of Pittsburgh), county and state), 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 its 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__________________________________ Type or Print Name __________________________________Title__________________________________Corporation Assignment of Lien Page 2 of 2Attest: Secretary COMMONWEALTH OF PENNSYLVANIACOUNTY OF _________________ On this, the ___ day of __________, 20____, before me a notary public, the undersigned officer, personally appeared________________, as the __________________ (type of authority, e.g., officer, trustee, etc.) of _________________________________ (name of party on behalf of whom instrument was executed) known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. In witness hereof, I hereunto set my hand and official seal. ___________________________ Notary Public ___________________________ Printed Name (Stamp or Seal)________________ My Commission Expires: _____________________