Fill and Sign the Wisconsin Assignment Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ___________________ Company: ____________________ Address: ______________________ City: ________________________ State: _____ Zip: _________ Parcel ID Number: ______________ Phone: _____________________ Fax: _____________________ ASSIGNMENT OF LIEN- INDIVIDUAL Beginning on or about the _____ of _______________ , 20 _____ , the undersigned lienor, __________________________________ , furnished or supplied labor, materials, or laborers to ___________________________________ for the purpose of improvements of real property located at and described as: _________________________________________________________________ , (legal description should include t he platting information (if property is platted), or if unplatted, then "metes and bounds" tied into the Public Land Survey System; Public Land Survey Information; municipality (e.g Town, Village or City of Paradise); and county) such that the undersigned lienor is entitled to a lien for the value of labor, materials, or laborers supplied. Notice is hereby given that the above-mentioned lienor does hereby assign his or her claim and lien to ___________________________________ , who shall hereafter have all the rights and remedies under law to which the lienor is entitled subject to all defenses thereto that might be made if such assignment had not been made, for the purpose of filing and for the enforcement of the above-mentioned lien. This the _____ day of _______________ , 20 ______ . __________________________________ Signature of Lien Holder _____ _____________________________ Type or Print Name This instrument was drafted by _______________ (name). Assignment of Lien Page 1 of 2 STATE OF WISCONSIN COUNTY OF ________________ This instrument was acknowledged before me this _____ day of ________________ , 20 _____ by _________________________________ . ______________________________ Notary Public (Seal, if any) 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 property owner __________________________________ by: ( ) Personal Delivery ( ) Mailing a true and correct copy of same by registered U.S. mail, postage prepaid, return receipt requested to _________________________________ . So certified this the _____ day of _______________ , 20 ______ . ________________________ Signature Assignment of Lien Page 2 of 2