Fill and Sign the Release of Lien Individual Arkansas 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- INDIVIDUAL On this _____ day of __________ , 20 ______ , on behalf of ___________________________________ , the undersigned does hereby acknowledge receipt of payment from _________________________________ in the amount of $ _________________ which represents full payment for labor performed and materials furnished by __________________________________ in reference to the work on the following described property: _____________________________________ . ___________________________________ hereby releases any lien it may have in connection with the above - described work including any lien for labor performed and materials furnished. _________________________ Signature ____________________________________ Print or Type Name Release of Lien Page 1 of 2 State of ____________________ County of ____________________ On this ________ day of ____________________ , 20 ________ , before me, _____________________________ a Notary Public, (or before any officer within this State or without the State now qualified under existing law to take acknowledgments,) appeared the within named ____________________________________ [and ____________________ ], to me personally well known (or satisfactorily proven to be such person), who stated and acknowledged that ____________________________________ [he, she or they] had so signed, executed and delivered said foregoing instrument for the consideration, uses and purposes therein mentioned and set forth. IN TESTIMONY WHEREOF, I have hereunto set my hand and official seal this ________ day of ____________________ , 20 ________ . (Notary Seal) ___________________________ NOTARY PUBLIC My Commission Expires: ____________________