STATE OF __________
COUNTY OF _________
__________________________________, referred to as HOLDER, is the owner of a lien related to ____________________, executed by _____________________, acknowledges payment in full of the same, which was recorded at _________________Book, page ___ of the ________ County, State of _________, and consents to the release of the property from the lien. In addition, I will sign whatever additional papers are necessary to perfect the elimination and extinguishment of my former lien.
__________________________________, having being duly sworn to tell the truth, acknowledges the execution of this release of lien for the purposes stated herein.
My commission expires: ___________________