For and in consideration of the amount of $___________ previously paid, and for and in consideration of the additional sum of $_________________ hereby acknowledged as being received by _______________________, the said _________________, does hereby fully, finally, and completely release that certain Notice of Mechanic’s Lien in the amount of $_______________ filed on _____________________, by said ________________________, and of the record in the Office of the Clerk of the County Commission of __________, West Virginia, in Mechanic’s Lien Book ______ at Page ____ with recordation date of _______________, filed against _________________________, (and any other such property owner’s name as may be used in the Notice of Mechanic’s Line), and this release applies to said lien as it may relate to _________________, its parent and subsidiaries, and their shareholders, officers, directors, successors, assigns and representatives, and __________, with the debt secured by said lien having been finally settled, discharged and extinguished including all interest, costs, and attorney fees due or claimed to be due on said debt which arose on or about _________________ as claimed by the aforementioned mechanic’s lien.
IN WITNESS WHEREOF, said ________________________ by its duly authorized representative, has caused its name to be signed to this Partial Release of Mechanic’s Lien.
Dated and signed this ____ day of _________________, 20__.
**
By:_____________________
Its: _____________________
STATE OF ___________________
COUNTY OF__________________
I, __________________, a notary public of said county, do certify
that _________, did on this the _____ day of _______, 20__ appear before me, the undersigned notary, and signed the foregoing Partial Release of Mechanic’s Lien, bearing the date of the _____ day of _______, 20___, and did further,
under oath, before me, acknowledge that he was duly authorized to sign
the foregoing release and that it was a lawful act and deed of ___________________, a corporation.
My commission expires ___________________.
____________________
NOTARY PUBLIC