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Fill and Sign the Release Lien 497300993 Form

Fill and Sign the Release Lien 497300993 Form

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Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ____________________ Company: ____________________ Address: _____________________ City: _____________________ State: _____ Zip: ________ Phone: _______________________ Fax: __________________________ DISCHARGE AND RELEASE OF LIEN – INDIVIDUAL (Conn. Gen. Stat. § 49-51) COMES NOW, __________________________________ , as a party having filed a certificate of lien claiming a lien interest in the real property described as: ________________________________________________________________________ _______________________________________________________________________ , and would state as follows: 1. On or about the _____ day of ________________ , 20 _____ , the undersigned; ( ) received a request from ______________________________ , requesting a release of the above-mentioned lien. ( ) received satisfaction of the lien claim in full. 2. The undersigned filed a certificate of lien on or about the _____ day of ____________________ , 20 _____ , said lien being recorded in the records of ____________________________ , Town __________________ , Volume ___________ , Page ___________ . 3. Pursuant to Conn. Gen Stat §49-51, §49-59, and § 52-380d, the undersigned hereby fully and completely discharges and releases said lien. This the _____ day of __________________ , 20 ______ . _________________________ Signature _____ ____________________ Print or Type Name Discharge and Release of Lien Page 1 of 2 ________________________ Witness ________________________ Witness State of Connecticut County of __________________ On this the ____________ day of _____________________, ____________, before me, ________________________ (name of notary), personally appeared ____________________________________, known to me (or satisfactorily proven) to be the person(s) whose name(s) _________ ( is or are) subscribed to the within instrument and acknowledged that ________________________ (he/she/they) executed the same for the purposes therein contained. In witness whereof I hereunto set my hand. Date:___________________________ ______________________________ Notary Public Print Name: ___________________ My Commission Expires: ____________________ Discharge and Release of Lien Page 2 of 2

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