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SAMPLE MECHANIC’S LIEN
STATE OF _______________
COUNTY OF ________________
I, the undersigned, whose address is __________________________________, affirm that in accordance with a contract between myself and _________________________, I furnished labor, services or materials consisting of:
[DESCRIPTION OF LABOR, SERVICES, AND/OR MATERIALS]
of a total value of ____________________ Dollars ($ ) of which there remains unpaid amount of _________________ Dollars ($ ), on the following described real property located at ________________________________ in _____________ County, State of _____________________:
[DESCRIPTION OF REAL PROPERTY]
which is owned by ___________________. I furnished the first of the labor, service, or materials on the ____ day of _______________, 20__ .
Claimant hereby declares that there is now due the balance of _______ Dollars ($) which respondents neglect and refuse to pay despite requests and demands for payment. For this reason, Claimant is entitled to a lien on the property described herein and the improvements located thereon for the total sum of the lien claimed along with interest on the maturity of the debt as allowable according to Statute in such cases made and provided.
ACKNOWLEDGEMENT OF NOTARY PUBLIC
Subscribed and sworn before me on this ___ day of ___________, 20__.
WITNESS my hand and seal.
My commission expires:
This form has been prepared for general informational purposes only. It does not constitute legal advice, advertising, a solicitation, or tax advice. Transmission of this form and the information contained herein is not intended to create, and receipt thereof does not constitute formation of, an attorney-client relationship. You should not rely upon this document or information for any purpose without seeking legal advice from an appropriately licensed attorney, including without limitation to review and provide advice on the terms of this form, the appropriate approvals required in connection with the transactions contemplated by this form, and any securities law and other legal issues contemplated by this form or the transactions contemplated by this form.
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