THE FOLLOWING INFORMATION IS SUBMITTED IN ACCORDANCE WITH s. 55.206, FLORDIA STATUES, TO AMEND INFORMATION SHOWN ON THE RECORDS OF THE DEPARTMENT OF STATE. JUDGMENT DEBTOR(S) 1. JUDGMENT DEBTOR (DEFENDANT) NAME AS SHOWN ON THE RECORDS OF THE DEPARTMENT OF STATE: ___________________________________________________________________________________________________________________ INDIVIDUAL OR BUSINESS ENTITY NAME ___________________________________________________________________________________________________________________ MAILING ADDRESS ___________________________________________________________________________ CITY ADDITIONAL JUDGMENT DEBTOR, IF APPLICABLE: _______________ ST _____________________ ZIP JUDGMENT LIEN AMENDMENT STATEMENT DO NOT PHOTOCOPY THIS FORM PRIOR TO USE. BAR CODE MUST BE LEGIBLE. 2. ___________________________________________________________________________________________________________________ INDIVIDUAL OR BUSINESS ENTITY NAME ___________________________________________________________________________________________________________________ MAILING ADDRESS ___________________________________________________________________________ CITY _______________ ST _____________________ ZIP JUDGMENT CREDITOR(S) 3. JUDGMENT CREDITOR (PLAINTIFF) NAME AS SHOWN ON THE RECORDS OF THE DEPARTMENT OF STATE: ___________________________________________________________________________________________________________________ CREDITOR NAME(S) ___________________________________________________________________________________________________________________ MAILING ADDRESS ____________________________________________________________________________ CITY ________________ ST ___________________ ZIP THIS SPACE FOR USE BY FILING OFFICER 4. 6. __________________________________________________________________ ENTER FILE NUMBER ASSIGNED TO ORIGINAL JUDGMENT LIEN BY DEPARTMENT OF STATE 5. ___________________________________________ DATE JUDGMENT LIEN FILED WITH DEPARTMENT OF STATE AMENDMENT PARTIAL RELEASE THE JUDGMENT LIEN BEARING THE FILE NUMBER INDICATED ABOVE IS AMENDED AS SET FORTH BELOW. THE JUDGMENT LIEN BEARING THE FILE NUMBER INDICATED ABOVE HAS BEEN PARTIALLY RELEASED AND THE VALUE OF THE LIEN REMAINING UNPAID AS OF THE DATE OF THIS STATEMENT $ ____________________. ASSIGNMENT ALL OF THE JUDGMENT CREDITOR'S RIGHTS UNDER THE JUDGMENT LIEN CERTIFICATE INDICATED ABOVE HAVE BEEN ASSIGNED TO THE NEW JUDGMENT LIENOWNER WHOSE NAME AND ADDRESS ARE LISTED BELOW. THE JUDGMENT CREDITOR NO LONGER CLAIMS A LIEN ON THE PERSONAL PROPERTY UNDER THE JUDGMENT LIEN BEARING THE NUMBER INDICATED ABOVE. TERMINATION 7. SHOW NAME AND ADDRESS OF ASSIGNEE AND/OR AMENDMENT INFORMATION HERE: (ATTACH PAGE, IF NECESSARY) UNDER PENALTY OF PERJURY, I hereby certify that: (1) All of the information set forth above is true, correct, current and complete; and (2) I have complied with all applicable laws in submitting this Judgment Lien Amendment Statement for filing. OWNER'S ATTORNEY OR AUTHORIZED REPRESENTATIVE TO WHOM ACKNOWLEDGMENT/CERTIFICATION OF FILING WILL BE MAILED: ____________________________________________________ Signature of Judgment Creditor or Authorized Representative _____________________________________________________________________________________________________________ NAME ____________________________________________________ Printed Name _____________________________________________________________________________________________________________ MAILING ADDRESS NON-REFUNDABLE PROCESSING FEE: __________________________________________________________ CITY ______________________ ST _________________________ ZIP JUDGMENT LIEN AMENDMENT STATEMENT $20.00 EACH ATTACHED PAGE, IF NECESSARY IF MORE THAN ONE DEBTOR BEING ADDED, FOR EACH ADDITIONAL $5.00 $ 5.00 CR2E094 (10/09) CERTIFIED COPY REQUESTED $10.00 Division of Corporations x P.O. Box 6250 x Tallahassee, Fl 32314 x 850-245-6011 Make Checks Payable to: Florida Department of State American LegalNet, Inc. www.FormsWorkFlow.com