RELEASE OF LIEN AGAINST PUBLIC FUNDS Know all men by these presents, ____________________ filed an Affidavit of Claim against _________________ with the _______, ______ Recorder's Office on __________, 20___, bearing Instrument No.____________, for $_________ in connection with a certain contract between ______________, the Contractor, and ______________, for labor or work performed and/or material furnished. ____________________, in consideration of the payment to it of the sum of $_____________, receipt of which is hereby acknowledged, does hereby release and forever discharge the Lien, from all claims and interest by reason of the filing said lien. Executed at _________________, _____, this _______ day of _____________, 20__. In the Presence of: _______________________________
STATE OF _____ ________
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Before me, a Notary Public in and for said State, personally appeared the above-named _________________, who acknowledged that he/she did sign the foregoing instrument and the same is his/her free act and deed. IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed my official seal at ________________, _______, this ________ day of ____________________, 20__.