RECORDING REQUESTED BY:
AND WHEN RECORDED MAIL TO:
(City, State & Zip)
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: _________________________
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),