Fill and Sign the South Dakota Individual Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: _________________ Company: ____________________ Address: _____________________ City: ________________ State: _____ Zip: ________ Phone: _________________ Fax: _________________ ACKNOWLEDGEMENT OF SATISFACTON OF LIEN-INDIVIDUAL (S.D. Codified Laws Ann. §44-9-21) COMES NOW, _________________________________ , as a party claiming a lien on the property described as ________________________________________________________________________ and would state as follows: 1. The undersigned recorded a lien against the above described property, owned by __________________________________ , on the _____ day of _______________ , 20 ______ , in the amount of $ _____________ . 2. The undersigned hereby acknowledges that on or about the _____ day of ______________ , 20 ______ , the undersigned received a payment from _________________________________ in the amount of $ _______________ . 3. Said amount represents payment in full for labor performed and/or materials furnished by the undersigned for the following described improvements and/or materials: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ . 4. By this document the undersigned lien claimant hereby releases any lien he or she may have in connection with the above - described property for labor performed and materials furnished and acknowledges the satisfaction thereof. This the _____ day of ______________ , 20 ______ . __________________________________ Signature of Lien Holder _____ _____________________________ Type or Print Name Acknowledgement of Satisfaction of Lien Page 1 of 2 __________________________________ ___________________________________ Witness Witness State of South Dakota County of __________________ On this ______ day of __________________ , 20 ______ , before me, ______________________________ , the undersigned officer, personally appeared ______________________________ , known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument and acknowledged that he/she executed the same for the purposes therein contained. In witness whereof I hereunto set my hand and official seal. Notary Public, State of       My commission expires:       Type or Print Name Acknowledgement of Satisfaction of Lien Page 2 of 2