Mechanics Lien Form - Blank

Download a blank fillable Mechanics Lien Form - Blank in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Mechanics Lien Form - Blank with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.


Recording Requested By and When Recorded Mail To:
Space above this line for recorder’s use only
(To be recorded in the county recorder’s office
in the county in which the property is located.)
(legal name and address), claims a lien for labor,
service, equipment, or material under the laws of the State of ___________________, upon the premises hereinafter
described, and upon every estate or interest in such structures, improvements and premises held by any party holding any
estate therein. The work was furnished for the construction of those certain buildings, improvements, or structures, now
upon that certain parcel of land situated in the County of ____________________, State of ___________________, said
land described as follows:
STREET ADDRESS: ____________________________________________________________
LEGAL DESCRIPTION: ____________________________________________________________
The lien is claimed for the following labor, service, equipment or material furnished by the Claimant:
(describe generally). Claimant is owed $
for work furnished to the work of improvement, after deducting
all just credits and offsets, plus interest at the legal rate from the date of this lien. The name of the person or company by
whom Claimant was employed, or to whom Claimant furnished the work is:
The name(s) and address(es) of the owner(s) or reputed owner(s) of the real property is/are:
Name of Claimant:
Print Name & Authorized Capacity
I, the undersigned, declare: I am the
(authorized capacity/title), for the Claimant named in the foregoing claim of mechanics lien:
I am authorized to make this verification for the Claimant: I have read the foregoing claim of mechanics lien and know the contents thereof, and the
same is true of my knowledge. I certify (or declare) under penalty of perjury under the laws of the State of ____________ that the foregoing is true
and correct.
Executed on
, 20 _____ at __________________________________ . _____________________________________________
Signature of Claimant or Authorized Agent
C&B Forms - revised March 2012
Page One
Page Two


00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Page of 2