Fill and Sign the Tx 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:       NOTICE OF CONFIDENTIALITY RIGHTS: IF YOU ARE A NATURAL PERSON, YOU MAY REMOVE OR STRIKE ANY OF THE FOLLOWING INFORMATION FROM THIS INSTRUMENT BEFORE IT IS FILED FOR RECORD IN THE PUBLIC RECORDS: YOUR SOCIAL SECURITY NUMBER OR YOUR DRIVER’S LICENSE NUMBER. REQUEST FOR RELEASE OF LIEN-INDIVIDUAL The undersigned individual, ________________________________ , as owner, original contractor or other person who has made a payment or satisfied a debt for labor and/or materials provided for the improvement of the property located at ______________________________________________________________________________ hereby requests that you, as the person who furnished such labor and/or materials, furnish a release of the indebtedness of any lien claimed on the above property to the extent that the indebtedness has been paid. Please provide such release by no later than the 10 th day after the date of receipt of this written request. Signed on the _____ day of _______________ , 20 _____ . Signature       Printed Name Address:                   Phone:       Request for Release of Lien Page 1 of 2 DO NOT SIGN BLANK OR INCOMPLETE FORMS. RETAIN A COPY. Subscribed and sworn to this _____ day of ______________ , 20 ____ , at ________________ , ____________ . Signature and Acknowledgment of Individual Owner       STATE OF TEXAS COUNTY OF       This instrument was acknowledged before me on ______(date)______ by (name or names of person or persons acknowledging) . Notary Public Printed Name:       My Commission Expires:       Certificate of Delivery I,       , hereby certify that I have delivered this day a true and correct copy of the foregoing to       by: Hand Delivery Mailing a true and correct copy of same by Certified or Registered U.S. Mail, postage prepaid, to       , at his/her usual place of business located at       . So certified this the _____ day of _______________ , 20 _____ . Signature TX Code § 53.152 Request for Release of Lien Page 2 of 2