SOUTHERN TITLE INSURANCE CORPORATION

RELEASE OF LIENS

(CONSTRUCTION IN PROGRESS)

The undersigned is a general contractor, subcontractor, materialman or other person, corporation, partnership or other entity furnishing services, labor or material in the construction or repair of improvements upon real estate owned by ___________________________________________________________

and briefly described as follows:

___________________________________________________________________

In consideration of the sum of $1.00 to the undersigned in hand paid, receipt whereof and sufficiency of which is hereby acknowledged, and other benefits accruing, the undersigned does hereby waive, release and quitclaim in favor of (1) the owner of said real estate, as improved, (2) each and every party making a loan on said real estate, as improved, and (3) Southern Title Insurance Corporation, and their respective successors and assigns, all right or claim that the undersigned may have to a lien upon the land and improvements above described.

IT IS UNDERSTOOD AND AGREED THAT THIS WAIVER AND RELEASE IS FOR ALL SERVICES RENDERED, WORK DONE AND MATERIAL FURNISHED PRIOR TO THE DATE HEREOF and is for all such services rendered, work done and material furnished and not only for the particular item indicated below.

Witness the following signature and seal this ________ day of _______________, 20_____.

FIRM:

BY:________________________________ (SEAL)

TITLE: _______________________________

____________________________________

(Print Name)

____________________________________

(Phone Number)

____________________________________

(Services, labor or material furnished)

COMMONWEALTH OF VIRGINIA

COUNTY/CITY OF __________________________

Executed, subscribed and sworn to before me on the day, month and year above written.

_________________________________________

Notary Public

My commission expires:_______________________

STIC Form #121  6/92