__________________ at ________________ filed for record in the office of _______________ a claim of lien that was recorded in Volume ____________, page ___________ of the Lien Records of the County of _______________ . The lien holder gave notice of a lien on _____________________ of _____________ of ____________________ for such property.

On _____________________ the owner fully satisfied the provisions described in the mentioned claim of lien. Therefore, the lien holder releases the mentioned claim of lien against the property of the owner and allows for lien to be discharged.

Pursuant to _________________________, the lien holder authorizes and directs the County Recorder of ________________ County, __________________ State, to discharge of record the described lien.

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Signature Date

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Signature Date