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Claim of Lien

This document is a claim of lien filed against a property located in [County], [State]. It states that [Name of Person Claiming Lien] furnished labor and/or materials for the property pursuant to an agreement, with a total value of $[Amount] of which $[Amount] remains unpaid. The first item was furnished on [Date] and the last item was furnished on [Date]. The lien is being claimed against the property owned by [Owner's Name] located at [Owner's Address] in the amount of $[Amount] that remains unpaid.

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j weiss
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484 views2 pages

Claim of Lien

This document is a claim of lien filed against a property located in [County], [State]. It states that [Name of Person Claiming Lien] furnished labor and/or materials for the property pursuant to an agreement, with a total value of $[Amount] of which $[Amount] remains unpaid. The first item was furnished on [Date] and the last item was furnished on [Date]. The lien is being claimed against the property owned by [Owner's Name] located at [Owner's Address] in the amount of $[Amount] that remains unpaid.

Uploaded by

j weiss
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Recording requested by: _______________

Space above reserved for use by Recorder’s Office


When recorded, mail to: Document prepared by:
Name: _____________________________________ Name ____________________________________
Address: ___________________________________ Address ___________________________________
City/State/Zip: ______________________________ City/State/Zip ______________________________

Claim of Lien
State of ______________________
County of _______________________

I, ________________________________ , being duly sworn, state the following:


In accordance with an agreement to provide labor and/or material, I did furnish the following labor and/or
materials:

on the following described real property located in ___________________________ County,


State of ___________________ , commonly known as:

and legally described as:

which property is owned by______________________________________________ , whose address is


_________________________________________________ , of a total value of $ ____________ ,
LF136 Claim of Lien Pg.1 (08-09)
of which there remains unpaid $ _____________ , and I further state that I furnished the first of the items
on the date of _______________ , and the last of the items on the date of _______________ .

I hereby, under the laws of the State of ___________________ , claim a lien against the above-described
property in the amount of money, stated above, which remains unpaid to me.

___________________________________________ _______________________________________
Signature of Person Claiming Lien Name of Person Claiming Lien

Address of person claiming lien:

On ________________________________ , __________________________________ came before


me personally and, under oath, stated that he/she is the person described in the above document and that
he/she signed the above document in my presence.

______________________________________________
Notary Signature

Notary Public,
In and for the County of _____________________ State of ________________________
My commission expires: ____________________ Seal

CERTIFICATE OF MAILING

I, ____________________________ , certify that on this date, ________________ , I have mailed a copy


of this Claim of Lien by USPS certified mail, return receipt requested, in accordance with the law, to:
Name: _____________________________________________________
Address: ___________________________________________________
Date: ______________________________________________________

___________________________________________ _______________________________________
Signature of Person Mailing Claim of Lien Name of Person Mailing Claim of Lien
LF136 Claim of Lien Pg.2 (08-09)

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