Fillable Printable Release and Discharge Mechanics' Lien Form
Fillable Printable Release and Discharge Mechanics' Lien Form
Release and Discharge Mechanics' Lien Form
RELEASE AND DISCHARGE OF MECHANIC’S LIEN
TO: The Clerk of the County of , State of New York, and all others interested.
PLEASE TAKE NOTICE, that , Lienor, had and claimed a Mechanic’s Lien pursuant to
the Lien Law of the State of New York, which Lien was filed with the Office of the Clerk of the
County of on , 20 against the real property known as and designated
as tax block , lot no. , a copy of which Lien is annexed hereto.
PLEASE TAKE FURTHER NOTICE, that , Lienor hereby consents to the release and
discharge of the aforesaid Mechanic’s Lien and directs that the Clerk of the County of
discharge said Mechanic’s Lien of record.
Dated: , New York
, 20 . LIENOR
________________________________
By: _____________________________
ACKNOWLEDGEMENT TAKEN IN NEW YORK STATE
State of New York, County of , ss:
On the day of in the year , before me, the
undersigned, personally appeared , personally known to
me or proved to me on the basis of satisfactory evidence to be
the individual(s) whose name(s) is (are) subscribed to the
within instrument and acknowledged to me that he/she/they
executed the same in his/her/their capacity(ies), and that by
his/her/their signature(s) on the instrument, the individual(s), or
the person upon behalf of which the individual(s) acted,
executed the instrument.
ACKNOWLEDGEMENT BY SUBSCRIBING WITNESS
TAKEN IN NEW YORK STATE
State of New York, County of , ss:
On the day of in the year , before me, the
undersigned, a Notary Public in and for said State, personally
appeared , the subscribing witness to the foregoing
instrument, with whom I am personally acquainted, who, being
by me duly sworn, did depose and say that he/she/they
reside(s) in
(if the place of residence is in a city, include the street and street number if any,
thereof); that he/she/they know(s)
to be the individual described in and who executed the
foregoing instrument; that said subscribing witness was
present and saw said
execute the same; and that said witness at the same time
subscribed his/her/their name(s) as a witness thereto
ACKNOWLEDGEMENT TAKEN IN NEW YORK STATE
State of New York, County of , ss:
On the day of in the year , before me, the
undersigned, personally appeared , personally known to
me or proved to me on the basis of satisfactory evidence to be
the individual(s) whose name(s) is (are) subscribed to the
within instrument and acknowledged to me that he/she/they
executed the same in his/her/their capacity(ies), and that by
his/her/their signature(s) on the instrument, the individual(s), or
the person upon behalf of which the individual(s) acted,
executed the instrument.
ACKNOWLEDGEMENT TAKEN OUTSIDE NEW YORK
STATE
*State of , County of , ss:
*(Or insert District of Columbia, Territory, Possession or Foreign
County)
On the day of in the year , before me,
the undersigned personally appeared
Personally known to me or proved to me on the basis of
satisfactory evidence to be the individual(s) whose name(s) is
(are) subscribed to the within instrument and acknowledged to
me that he/she/they executed the same in his/her/their
capacity(ies), that by his/her/their signature(s) on the
instrument, the individual(s) or the person upon behalf of which
the individual(s) acted, executed the instrument, and that such
individual make such appearance before the undersigned in
the
(add the city or political subdivision and the state or country or
other place the acknowledgement was taken).
Title No.
TO
SECTION:
BLOCK:
LOT:
COUNTY OR TOWN:
RETURN BY MAIL TO:
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