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Release Of Mechanics Lien Form

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Recording Requested By And Mail To:

Space above this line for recorders use only

RELEASE OF MECHANICS LIEN

The undersigned Claimant,

does hereby release that certain

Mechanics Lien, dated

, and recorded as instrument No.

, in the Official Records of

County, and in which Mechanics Lien

____________________________________________is named as the owner or reputed owner of the property described

in said lien, and

is named as person or company by whom claimant

was employed or to whom claimant furnished labor, services, equipment, or materials and does hereby releases the

premises described therein from the said claim of lien and hereinafter set forth, which premises are described as follows:

STREET ADDRESS:

and/or

LEGAL DESCRIPTION:

Date:

Name of Claimant: ____________________________________

By: _______________________________________

Signature

_____________________________________________

Authorized Capacity

CERTIFICATE OF ACKNOWLEDGMENT

State of California,

Capacity claimed by signer:

[ ] Individual

County of ______________________

[ ] Corporate Officer(s)

On ____________________, before me, ________________________, Notary Public, personally

Titles: _________________

date

[ ] Partner(s) __Limited__General

[ ] Attorney-in-fact

appeared __________________________________________, who proved to me on the basis of satisfactory

[ ] Trustee(s)

evidence to be the person(s) whose names(s) is/are subscribed to the within instrument and acknowledged to

[ ] Guardian/Conservator

[ ] Other: ___________________

me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their

Signer is representing names of

signature(s) on the instruments the person(s), or the entity upon behalf of which the person(s), or the

person(s) or entity(ies):

entity upon behalf of which the person(s) acted, executed the instrument.

__________________________

I certify under PENALTY OF PERJURY under the laws of the State of California that the

foregoing paragraph is true and correct.

WITNESS my hand and official seal:

Signature: ____________________________________

C&B Revised 3/2012

Release Of Mechanics Lien Form

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