Letter of Claim of Lien : Please fill out the following form. Please print your completed form if you would to have a copy for your records.
STATE OF :
COUNTY OF :
BEFORE ME, the undersigned Notary Public, personally appeared (Name of the person claiming lien) who duly sworn says that he is (the lienor herein) (the agent of the lienor herein) whose address is (Address of the person claiming lien) and that in accordance with a contract with (Name of the person or the company who hired lienor) lienor furnished labor, services or materials consisting of (Brief description of the labour or materials furnished) on the following described real property in (name of the county) County, State of (Name of the state) described as (description of the real property) and owned by (Name of the person who owns the property) of a total value of (Total value of the job) dollars ($____________) ofwhich there remains unpaid $________, and furnished the first of the items on (date with year) by (name of the person who finishes the items) and (if required) that the lienor served copies of the notice on the contractor on (date with year) by (name of the person who finishes the items) and on the subcontractor (Name of the subcontractor) on (date with year) by (Name of the person who served the notice to the subcontractor).
On _______________________ before me _________________________ personally appeared ___________________________ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS my hand and official seal.
Affiant : Known / Unknown :
ID Produced :
Letters Used in Real Estate Index
Letter of Claim of Lien
to HOME PAGE