Texas Affidavit For Mechanic'S And Materialman'S Lien Form

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AFFIDAVIT FOR MECHANIC'S AND MATERIALMAN'S LIEN
"NOTICE: THIS IS NOT A LIEN. THIS IS ONLY AN AFFIDAVIT CLAIMING A LIEN."
THE STATE OF TEXAS
§
§
COUNTY OF __________
§
BEFORE ME, the undersigned authority, on this day personally appeared ___________________
who upon his oath did depose and state as follows:
"My name is _________________________ and I am a resident of _____________ of
____________________ County, Texas. I am the ________________________ of
_____________________________, a Texas corporation, hereinafter sometimes referred
to as "Claimant", I am over 18 years of age, the facts set forth below are true and correct
and am competent and authorized to make this Affidavit on Claimant's behalf.
Claimant's
physical
address
is
________________________________________
Claimant's mailing address is _______________________________________________.
Pursuant to a Contract by and between Claimant and _____________________________
Claimant has provided _________________________ to improve the real property
described herein. The materials, labor and/or equipment were provided for such
improvement
to
_______________________.
The
last
known
address
of
________________________________ is _______________________________. The
project
is
known
as
____________________________
located
at
______________________________ in ___________________ County, Texas (tthe
"Project").
The Original Contractor for the improvements for which a lien is claimed is
_____________________,
whose
last
known
business
address
is
____________________________________________.
The Owner or reputed Owner of the real property and of the improvements on which
Claimant asserts a lien is __________________________. Owner's last known business
address is _________________________________.
After allowing all just credits, offsets ________________________ and payments, the
amount of ________________________ /100 Dollars ($_______________) remains
unpaid and said sum is due and owing to Claimant under said Contract. Claimant claims a
lien on said property and improvements under the provisions of Chapter 53 of the Texas
Property Code to secure payment of the above amount. The amount claimed includes
retainage in the amount of $________, which is now due and owing. This amount does
not include any attorneys' fees, interest or costs which may be recovered at law.
The Claimant provided the unpaid labor, material and/or equipment to the Project in the
months of _______________ through ___________________ as follows:
_________ [month, year]
$_______________
_________ [month, year]
$_______________

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