MECHANIC'S LIEN

 

 

RECORDING REQUESTED BY:

______________________________

 

 

AND WHEN RECORDED MAIL TO:

______________________________

(Name)

 

______________________________________________________________________

(Street Address)

 

______________________________

(City, State & Zip)

 

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SPACE ABOVE THIS LINE FOR RECORDER'S USE

 

 

The undersigned __________________________, claimant, claims a Mechanic's Lien upon the following described real property: __________________________________

_____________________________________________________________________.  The sum of __________________ Dollars ($__________), together with interest there upon at the highest legal rate per annum from ___________________________ is due claimant (after deducting all just credits and offsets) for the following work, equipment, and material furnished by claimant: ___________________________________________________________.

 

Claimant furnished the work and materials at the request of, or under contract with: _____________________________________________________________________.

 

The owners and reputed owners of the property is/are: __________________________ ____________________________________________________________________.

 

 

Firm Name: _______________________                By: _________________________

 

 

VERIFICATION

 

 

I, the undersigned, say: I am the claimant or agent or the claimant of the foregoing Mechanic's Lien.  I have read said claim or Mechanic's Lien and know the contents thereof.  The same is true of my own knowledge and I am authorized to execute this Claim of Lien.

 

I declare under penalty of perjury that the foregoing is true and correct.

 

Executed on ____________________________ (month & day), __________ (year), at _________________________ (City), ____________________________ (State).