[list name of lien holder], an individual with an address of [list address of lien holder] ("Lien Holder"), filed a certain lien on property of [list name of owner of property which has the lien], an individual with an address of [list address of property owner] ("Owner"), which property is described as follows:

    [enter full legal description of property].

    The above lien was recorded [list where and when lein was recorded].

    This lien was to secure a claim of the Lien Holder against the Owner for the following: [describe nature of work performed and materials supplied by lien holder].

    Now, in consideration of $[e.g. 1,000.00] and other valuable consideration paid by Owner, the receipt and sufficiency of which are acknowledged, Lien Holder does hereby:

    1. Release, discharge and terminate the above lien and certify that the claim secured thereby has been fully paid and satisfied;

    2. Release to the Owner all right, title and interest that the Lien Holder may have acquired in and to the above property by reason of such lien;

    3. Authorize and direct the Register of Deeds of said county to discharge and cancel the lien of record; and

    4. Release and forever discharge the Owner from all claims, causes of action, demands and liabilities of whatever nature which the Lien Holder ever had, now has or hereafter may have in connection with furnishing the above labor and/or materials.

    This instrument shall bind Lien Holder and its heirs, legal representatives, successors and assigns. This instrument shall inure to the benefit of Owner and its heirs, legal representatives, successors and assigns.


    IN WITNESS WHEREOF, this Release of Lien is executed under seal 

on the__________day of_________________, 19_____.

Executed in the presence of:

______________________________ ____________________________(Seal) (Signature of witness) [list name of lien holder]

______________________________ (Signature of witness) STATE OF _____________________

COUNTY OF ____________________

In _______________, on the _____________ day of ____________, 19___, before me, a Notary Public in and for the above state and county, personally appeared [list name of lien holder], known to me or proved to be the person named in and who executed the foregoing instrument, and being first duly sworn, such person acknowledged that he or she executed said instrument for the purposes therein contained as his or her free and voluntary act and deed.

                            NOTARY PUBLIC 

My Commission Expires: ________


After recording, return to:_____________________________________