Virginia > Statewide > Circuit Court > Probate
Memorandum For Mechanics Lien Claimed By General Contractor Under Virginia Code CC-1512 - Virginia
| Memorandum For Mechanics Lien Claimed By General Contractor Under Virginia Code Form. This is a Virginia form and can be used in Probate Circuit Court Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
MEMORANDUM FOR MECHANIC'S LIEN CLAIMED BY GENERAL CONTRACTOR UNDER VIRGINIA CODE ยง 43-5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Circuit Court .................................................................................................................................................................. ADDRESS TELEPHONE NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . or TAX MAP REFERENCE NUMBER ...................................................................................... PARCEL IDENTIFICATION NUMBER .................................................................................................................................................................. NAME OF OWNER .................................................................................................................................................................. ADDRESS OF OWNER .................................................................................................................................................................. NAME OF CLAIMANT .................................................................................................................................................................. ADDRESS OF CLAIMANT 1. Type of materials or services furnished: .................................................................................................................................. 2. 3. Amount claimed: $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Type of structure on which work done or materials furnished: .................................................................................................................................. 4. Brief description and location of real property: .................................................................................................................................. 5. Date from which interest on the above account is claimed: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The undersigned hereby certifies to mailing a copy of this memorandum of lien to the owner of the property at the property owner's last known address, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ADDRESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DATE OF MAILING ...................................................... DATE ________________________________________________________ SIGNATURE OF CLAIMANT American LegalNet, Inc. www.USCourtForms.com FORM CC-1512 (MASTER, PAGE ONE OF TWO) 12/05 AFFIDAVIT State of Virginia, County or City of I, ...................................................................................................................... , to wit: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . of NOTARY OR OTHER OFFICER the county (or city) aforesaid, do certify that agent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , claimant, or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , for claimant, this day made oath before me in my county (or city) aforesaid that ............................................................................................, owner, is justly indebted to claimant in the sum of $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . dollars, for the consideration stated in the foregoing memorandum, and that the same is payable as therein stated. Given under my hand this . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . day of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 20. . . . . . . . . . . . _________________________________________________ [ ] CLERK [ ] DEPUTY CLERK [ ] NOTARY My commission expires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . This instrument was admitted to record . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DATE TIME ............................................................, Clerk by. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , Deputy Clerk FORM CC-1512 (MASTER, PAGE TWO OF TWO) REVISED 05/04 American LegalNet, Inc. www.USCourtForms.com
|
|||||||
