Date:
ClaimantName:
Address:
License number:
Name:
Address:
Property informationProperty address:
Legal description:
Lien amount:
Claimed for:
dated
Other details:
Dear ,
I, , hereby assert a Contractor's (Mechanic's) Lien on the Property located at legally described as (the "Property"), as a result of the (the "Work Performed/Services Rendered") provided by me as agreed between the Parties in the dated .
The Work Performed/Services Rendered include but are not limited to the following:
The total amount owed for the Work Performed/Services Rendered is . However, to date, only partial payments in the amount of have been received, leaving a remaining outstanding balance of .
This notice serves as a formal notification of my intent to assert a lien on the Property mentioned above, as permitted by the laws of the State of .
If the owed amount is not paid within days from the receipt of this notice, I will file a lien with the appropriate authorities.
I urge you to address this matter promptly to avoid further legal action. If you have any questions or require additional information, please do not hesitate to contact me at .
Sincerely,
Signature: _____________________
State of
Acting in the county of
Sworn to and subscribed before me on ___________________________.
___________________________________
Place for signature
____________________________________
Notary public's name and seal
