Fill and Sign the Release Lien Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ___________________ Company: ___________________ Address: _____________________ City: __________________________ State: _____ Zip: _____________ Phone: _____________________ Fax: _______________________ RELEASE OF LIEN- CORPORATION STATE OF FLORIDA COUNTY OF ___________________ . KNOW ALL MEN BY THESE PRESENTS: THE UNDERSIGNED, for and in consideration of the payment of the sum of $ ___________________ , paid by _______________________ , the receipt of which is hereby acknowledged, by these presents does hereby waive, release, and quit - claim all liens, lien rights, claims or demands of every kind whatsoever against _____________________________ which the undersigned now has or may hereafter have, including without limitation, that certain Claim of Lien recorded in Official Record Book __________ , Page ________ , of the Public Records of ___________________ County, Florida, against that certain real estate and the improvements located thereon, situated in _____________________ County, Florida, and described as follows: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (legal description) on account of work and labor performed, and/or materials furnished in improving said above - described property, or any part thereof. The undersigned certifies that all labor, services and/or materials described herein have been provided prior to the execution and delivery of this document. WITNESS my hand and seal this _____ day of __________________ , 20 _____ . Corporate Lienor's Name _____________________ Address _______________________________ _____________________________________ By __________________________________ Signature Title _____ ___________________________ Printed Name _____ ____________________ Attest: Secretary STATE OF ___________ COUNTY OF _____________ Sworn to (or affirmed) and subscribed before me this _____ day of _________________, 20______ by _________________________ (name of person making statement) who is personally known to me or produced _________________________ as identification, and who did take an oath. ____________________________ NOTARY PUBLIC Printed Name of Notary _________________________ Commission Expires _________________________