RELEASE OF LIEN (PARTIAL OR FULL) WORKSHEET FORM (Basic Information for Processing a Release of Lien) MID STATE NOTIFIER19 NW 8 ST, OCALA, FL 34475INFO@MIDSTATENOTIFIER.COM 352-861-9100 NOTE: Due to the high volume of storage, we will maintain and store records in our warehouse for a period of 2 years. If you have any need for the Notice to Owners, Proof of Service or Claim of Liens, it is your responsibility to notify us and obtain these records to avoid being destroyed. TYPE OF RELEASEPARTIALFULLTODAYS' DATE NTO DATE PROJECT NAMEPROJECT ADDRESS (CITY, ZIP)PROJECT COUNTYOWNER NAME AND ADDRESSLEGAL DESCRIPTIONDESCRIPTION OF WORKBOOK, PAGE & DATE OF RECORDED LIEN(INFORMATION WILL BE PROVIDED BY ME IF I DID THE LIEN)FIRST DATE ON THE JOB LAST DATE ON THE JOB RELEASE AMOUNT(THE AMOUNT OF MONEY YOU RELEASE ALL OR PARTIAL LIEN RIGHTS TO PROPERTY)YOUR INFORMATIONCOMPANY NAMECONTACT NAMEADDRESS STREET ADDRESS CITY STATE/PROVINCE ZIP/POSTAL CODE REPRESENTATIVE THAT WILL HAVE THEIR NAME SIGNED/NOTARIZED ON RELEASE(IT IS NOT NECESSARY TO NOTARIZE THIS FORM) PHONEFAXEMAIL* FILE Drop files here or CaptchaHuman Verification Process
