William J. Smith, currently residing or having a principle place of business at, 123 Carmel Street, City of ABC, County of DEF, State of GHI, hereby certify that the lien mentioned below was paid in full. In consideration of the payment made, the undersigned hereby consent that the lien is discharged and released.
The Lien that will be discharged and released was made by a notice of lien dated the 25th day of February, 2015 and it was filed by the lienor on the 13th day of March, 2015 with an amount of Twenty Five Thousand Dollars ($25,000) encumbering the real estate property known as ABC real estate.
Jimmy Buckets, an individual with an address of 123 Carmel Street, New York, filed a lien on the property of Vincent Morry, with an address of 456 Orange Street, New York, which property is fully described as follows:
[Full legal description of the property]
The lien mentioned above was recorded in [Date and Place where it is recorded]. The lien was made to secure a claim of Jimmy Buckets against Vincent Morry because of the following reasons:
[Claim of Lien Holder]
After paying $10,000 by the owner, the receipt will be acknowledged and the Lien Holder hereby:
Terminate the above lien and certify that the claim was full paid.
Release all right, title and interest of the Lien Holder to the owner because of the lien.
Forever discharge the owner for any claims, demands and liabilities connected to the lien made by the lien holder.
______________________________ ____________________________ (Seal)
(Signature of witness) [list name of lien holder]
(Signature of witness)
KNOW ALL MEN BY THESE PRESENTS that the undersigned [Name of the Lien Holder], having filed a lien claim against the property of [OWNER] on the 25th day of February, 2015, against the real estate property described as follows:
[Description of Property]
with an amount of Ten Thousand Dollars ($10,000).
As soon as the payment was received on the claim of lien, [LIEN HOLDER] hereby acknowledge the satisfaction of the claim and cancel and discharge the claim.
Name of Lienor