Mechanics Lien 1

RECORDING REQUESTED BY: AND WHEN RECORDED MAIL TO: (NAME) (STREET ADDRESS) (CITY, STATE, ZIP) SPACE ABOVE THIS LINE FOR RECORDER'S USE MECHANIC'S LIEN The Undersigned (COMPLETE NAME OF PERSON OR ENTITY CLAIMING MECHANIC'S LIEN) claimant, claims a Mechanic's Lien upon the following described real property: (STREET ADDRESS AND / OR LEGAL DESCRIPTION, IF AVAILABLE, WHERE THE WORK WAS FURNISHED) The sum of $ (AMOUNT DOE ON CLAIM) , together with interest there upon at the highest legal rate per is due claimant (after deducting all just credits and offsets) for annum from (DATE AMOUNT OF UNPAID CLAIM BECAME DUE) the following work, equipment, and material furnished by claimant: (GENERAL DESCRIPTION OF WORK AND/OR MATERIALS FROM CLAIMANT) Claimant furnished the work and materials at the request of, or under contract with (NAME(S) OR ENTITIES WHO CONTRACTED OR ORDERED THE WORK OR MATERIALS FROM CLAIMANT) The owners and reputed owners of the property is/are: (NAME OF EATON OF REAL PROPERTY THIS INFORMATION PAN BE OBTAINED FROM THE COUNTY REPORTER'S OFFICE OR THE BONDING DEPT ) Firm Name: By: (SIGNATURE OF CLAIMANT OR AUTHORIZED AGENT) VERIFICATION I, the undersigned, say: I am the claimant or agent of the claimant of the foregoing Mechanic's Lien; I have read said claim of Mechanic's Lien and know the contents thereof; the same is true of my own knowledge. I am authorized to execute this Claim of Lien. I declare under penalty of perjury that the foregoing is true and correct. Executed on (DATE OF SIGNATURE) , 19 , at (CITY AND STATE WHERE EXECUTED) (SIGNATURE OF THE INDIVIDUAL WHO VERIFIES THAT THE CONTENTS OF THE CLAIM OF MECHANIC'S LIEN ARE TRUE) 2001 © American LegalNet, Inc. American LegalNet, Inc. www.FormsWorkFlow.com