Fill and Sign the Tennessee Acknowledgment Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ___________________ Company: ____________________ Address: ______________________ City: _________________ State: ______ Zip: __________ Phone: ________________ Fax: _________________ Reference Instrument Number: ________________ ACKNOWLEDGEMENT OF SATISFACTON OF LIEN-CORPORATION (Tenn. Code Ann. § 66-11-135) This instrument was prepared by: Name: ___________________________________ Address: _______________________________________________________________ COMES NOW, _____________________________________ , as a representative of _________________________________ a __________________________________ corporation 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 $ ________________ . The reference instrument number is _______________ and the office, book and page number is _______________ . 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 the lien claimant may have in connection with the above - described property for labor performed and materials furnished and acknowledges the satisfaction thereof. Acknowledgement of Satisfaction of Lien Page 1 of 2 This the _____ day of _______________ , 20 ______ . __________________________________ Signature _____ _____________________________ Type or Print Name _____ ______________________________ Title _____ ______________________________ Corporation Attest: Secretary STATE OF TENNESSEE COUNTY OF _______________ Personally appeared before me, the undersigned, a Notary Public within and for said State and County aforesaid, duly commissioned and qualified, ___________________________________ of the state and county mentioned, personally appeared ___________________________________ , with whom I am personally acquainted (or proved to me on the basis of satisfactory evidence), and who, upon oath, acknowledged such person to be president (or other officer authorized to execute the instrument) of ___________________________________ , the within named bargainor, a corporation, and that such president or officer as such __________________________________ , executed the foregoing instrument for the purpose therein contained, by signing the name of the corporation by himself/herself as such officer. Witness my hand and seal, at office in _____ , this __________ day of ______ . Notary Public My commission expires:       Type or Print Name Acknowledgement of Satisfaction of Lien Page 2 of 2