Construction Lien Claim Page 4
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4State 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. Was authorized to and did execute this instrument as _______________________ of
_________________________________, the entity named in this instrument.
Signed: _________________________________________
Print Name: _____________________________________
Record and return to:
Name: ________________________________________________________
Address: ____________________________________________________________________________
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