Construction Lien Claim Page 3
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4Notice to Subcontractor or Contractor
This lien has been filed with the county clerk and served upon the owner of the real estate. This lien places the
owner on notice that this real estate may be sold to satisfy this claim unless the owner pays the claimed sum
to this claimant.
Date: ____________________
Signed: ___________________________________________________
Print Name/Title:___________________________________________
For: ______________________________________________________
Claimant’s Representation and Verification
Claimant represents and verifies that:
1. The amount claimed herein is due and owing at the date of filing, pursuant to the claimant’s contract
described in the construction lien claim.
2. The work, services, materials or equipment for which this lien claim is filed was provided exclusively in
connection with the improvement of the real property which is the subject of this claim.
3. This claim has been filed within 90 days from the last date upon which the work, services, materials or
equipment for which payment is claimed was provided.
4. The foregoing statements made by me are true, to the best of my knowledge. I am aware that if any of
the foregoing statements made by me are false, this construction lien claim will be void and that I will
be liable for damages to the owner or any person injured as a consequence of the filing of this lien
claim.
Date: ____________________
Signed: _____________________________________________________
Name/Title of Claimant: _______________________________________
Acknowledgments
State of New Jersey, County of __________________
SS:.
I certify that on ________________, ____________________________ personally came before me who stated
to my satisfaction that this person (or if more than one, each person):
a. Was the maker of the attached instrument; and,
b. Executed this instrument as his or her own act.
Signed: _________________________________________
Print Name: _____________________________________
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