Fillable State Of California Mechanics' Lien Claim Form printable pdf download

Recording requested by (name):

____________________________________________

When recorded, mail to (name and address):

____________________________________________

Recorder’s Use Only

MECHANICS' LIEN CLAIM

(Cal. Civ. Code § 8416)

_________________________________________________ (“claimant”) claims a mechanics lien for

the labor or services or equipment or materials described in paragraph 2, furnished for a work of improvement

on that certain real property located in the County of ____________________________, State of California,

and more particularly described as (address and/or sufficient description): ____________________________

________________________________________________________________________________________

After deducting all just credits and offsets, the sum of _______________________, together with

interest at the rate of ______ per annum from ________________ (date when balance became due), is due

claimant for the following labor, materials, services, or equipment:

________________________________________________________________________________________

Claimant furnished the labor or services or equipment or materials, at the request of

_________________________________________________________________ (employer, person, or entity

to whom labor, materials, services, or equipment were furnished).

The name and address of the owner or reputed owner of the real property is/are: ________________

________________________________________________________________________________________

Claimant's address is:

________________________________________________________________________________________

Dated ____________________

_______________________________________

(Signature)

VERIFICATION

I, _________________________________________, am the: ______________________________________

(“owner,” “president,” “authorized agent,” “partner,” etc) of claimant on the foregoing claim of mechanics lien,

and am authorized to make this verification for and on its behalf. I have read the foregoing claim of mechanics

lien and know the contents of the claim of mechanics lien to be true of my own knowledge.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Dated ____________________

_______________________________________

(Signature)

6/6/16

State Of California Mechanics' Lien Claim Form