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.
PLEASETAKENOTICE,that ,Lienor,hadandclaimedaMechanic’s Lienpursuantto
the LienLaw ofthe State ofNew York,which Lien wasfiled with the Office ofthe Clerkof the
Countyof on ,20 againsttherealpropertyknownas anddesignated
as tax block , lot no. , a copy of which Lien is annexed hereto.
PLEASETAKEFURTHERNOTICE,that ,Lienorherebyconsentstothereleaseand
dischargeoftheaforesaidMechanic’sLienanddirectsthattheClerkoftheCountyof
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:
Onthe dayof intheyear ,beforeme,the
undersigned,personallyappeared ,personallyknownto
me or proved to me onthe basis of satisfactory evidenceto be
theindividual(s)whosename(s)is(are)subscribedtothe
withininstrumentandacknowledgedtomethathe/she/they
executedthesameinhis/her/theircapacity(ies),andthatby
his/her/their signature(s) on the instrument, the individual(s), or
theperson uponbehalfofwhichtheindividual(s)acted,
executed the instrument.
ACKNOWLEDGEMENT BY SUBSCRIBING WITNESS
TAKEN IN NEW YORK STATE
State of New York, County of , ss:
Onthe dayof intheyear ,beforeme,the
undersigned,aNotaryPublicinandforsaidState,personally
appeared ,thesubscribingwitnesstotheforegoing
instrument,withwhomIampersonally acquainted,who,being
bymedulysworn,diddeposeandsaythathe/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)
tobetheindividualdescribedinandwhoexecutedthe
foregoinginstrument; thatsaidsubscribingwitnesswas
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:
Onthe dayof intheyear ,beforeme,the
undersigned,personallyappeared ,personallyknownto
me or provedto me onthe basis of satisfactoryevidence tobe
theindividual(s)whosename(s)is(are)subscribedtothe
withininstrumentandacknowledgedtomethathe/she/they
executedthesameinhis/her/theircapacity(ies),andthatby
his/her/their signature(s)on the instrument, theindividual(s), or
the personuponbehalf ofwhich theindividual(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 ,beforeme,
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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