Fill and Sign the Requested by and Return to Form

Release of Lien Claim Page 1 of 2Prepared by, recording requested by and return to:Name: Company: Address: City: State: Zip: Phone: Fax: ----------------------Above this Line for Official Use Only--------------------- RELEASE OF LIEN CLAIM--CORPORATION STATE OF ILLINOIS COUNTY OF _______________FOR THE PROTECTION OF THE OWNER, THIS RELEASE SHOULD BE FILED WITH THE RECORDER OR THE REGISTRAR OF TITLES IN WHOSE OFFICE THE CLAIM FOR LIEN WAS FILED.TO:Registrar of ____________ CountyThe below named Claimant, located at _______________________________________ ____________________________________ (address of Claimant), hereby directs you to discharge and release of record the following lien:Claim of Lien filed on the ______ day of __________________, 20____, at Book ________, Page __________ in the amount of ____________________ dollars, for the value of work, services, material or equipment, in accordance with a contract between Claimant and ________________________________. The owner of the property upon which the lien was filed is ______________________________, said property being located in ________________ County, Illinois, and being described as follows:[Describe Property or Attach Exhibit] The claim has been paid/satisfied/settled by the parties/ forfeited by the claimant. Release of Lien Claim Page 2 of 2 This the _____ day of ___________________, 20____. Corporation Name__________________________by SignaturePrint Name: ________________ Title: _____________________ STATE OF ILLINOISCOUNTY OF ___________________ The foregoing instrument was acknowledged before me this __________ day of _____________, 20___________ by _______________________________(name of officer or agent, title of officer or agent) of ________________________________(name of corporation acknowledging) a ______________________________________(state or place of incorporation) corporation, on behalf of the corporation. ______________________________Notary Public (SEAL) Printed Name: _________________ My Commission Expires: _____________________ (770 ILCS 60/35)