REQUEST FOR RELEASE OF LIEN

To: RCS Date_______________

Fax No.:602-279-3789

Please prepare a Release of Mechanic's Lien for the following:

Job Name____________________________________

Job Address__________________________________

As the person requesting this Release preparation, we appoint RCS to execute this document on our behalf.

Company Name____________________________________

Company Address__________________________________

City, State, & Zip____________________________________

Signature & Title of person authorizing this lien request:

_______________________________ ___________________

Signature Title