Claim Of Lien Form

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CLAIM OF LIEN
(Mechanics Lien Act)
To the Registrar of the Northwest Territories Registration District
I, (We),
of
(if so, an assignee of :)
claims a lien under the Mechanics Lien Act on the estate of
in the land described below in respect of the following work done (or materials or machinery furnished):
which work was (or is to be) done (or materials or machinery furnished) for
on or before
The amount claimed as due (or to become due) is the sum of
The following is the description of the land to be charged:
(When credit has been given, the following statement should be inserted. Delete if inapplicable.)
The work was done (or materials or machinery were furnished) and the period of credit, which was agreed
to, expired (or will expire) on
Dated at ______________________________ this _____ day of _____________________, 20_____.
______________________________
(Signature of Claimant)

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