KNOW ALL MEN BY THESE PRESENTS:
That the undersigned, for and in consideration of the payment
of the sum of
($ ) paid by , receipt of
which is hereby acknowledged, hereby releases and quit claims to its successors and assigns, and the owner, all liens, lien rights, claims or demands of any kind whatsoever, which the undersigned now has or might have against the building on premises legally described as on account of labor performed and/or material furnished
for the construction of any improvement thereon. That all labor and materials
used by the undersigned in the erection of said improvements have been
fully paid for.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of_____, 20 .
WITNESSES:
(SEAL)
By
STATE OF
COUNTY OF
I hereby acknowledge that the statements contained in the foregoing Release of Lien are true and correct.
Sworn to and subscribed before me this day of , 20 ______.
Notary Public
My commission expires: