Fill and Sign the Utah Lien 497427401 Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: _________________ Company: __________________ Address: ____________________ City: ________________ State: _____ Zip: __________ Phone: ________________ Fax: ________________ Nature of Document: Cancellation of Lien CANCELLATION OF LIEN- CORPORATION 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 $ _______________ . 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 cancels any lien the lien claimant may have in connection with the above - described property for labor performed and materials furnished. This the _____ day of ________________ , 20 ______ . __________________________________ Signature _____ _____________________________ Type or Print Name Cancellation of Lien Page 1 of 2 _____ _____________________________ Title _____ _____________________________ Corporation Attest: Secretary Acknowledgment of Corporation State of Utah County of __________________ On the ______ day of __________________ , 20 ______ , personally appeared before me ______________________________ ,who being duly sworn, did say that he/she is the ________________________ of ______________________________ , a corporation, and that said instrument was signed on behalf of said corporation by authority of a resolution of its Board of Directors, and said ______________________________ acknowledged to me that said corporation executed the same. (Seal) Notary Public My commission expires:             Type or Print Name Residing at:       Cancellation of Lien Page 2 of 2