Individual
FINAL RELEASE OF LIEN
Name (party of the First Part):
Description of What Was
Constructed:
Project Address or Location:
KNOW ALL MEN BY THESE PRESENTS, that the party of the First Part for and in consideration of the
sum of $10.00 and other good and valuable consideration paid to the party of the First Part by
Broward County, Florida (party of the Second Part), address 2555 West Copans Road, Pompano
Beach, Florida, 33069, receipt of which is hereby acknowledged, do hereby release and quit claim to
Broward County, Florida, its successors or assigns, all liens, lien rights, claims or demands of any kind
whatsoever, which now party of the First Part have or might have against the property, building and/or
improvements, on account of labor performed, material furnished, and/or for any incidental expense
for the construction as described above at the address or location described above.
(signed on the following page)
Page 1 of 2
Revised October 1, 2012
Page 2 of 2
Address:
Signature:
Type Name:
Witness One
Typed Name:
Witness One
Signature:
WITNESSES
Witness Two
Typed Name:
Witness Two
Signature:
ACKNOWLEDGEMENT
County of:
Date:
State of:
IN WITNESS WHEREOF party of the First Part has caused its name to be hereunto signed.
Address:
Type Name:
Signature:
(NOTARY SEAL)
(not required if digitally signed by Notary)
Type Name:
Notary Signature:
Type of Identification Produced:who
The foregoing instrument was acknowledged before me this date by
