State Of California Mechanics' Lien (Claim Of Lien) Form
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1
2
3RECORDING REQUESTED BY
WHEN RECORDED MAIL TO
SPACE ABOVE THIS LINE FOR RECORDER'S USE ONLY
Mechanics' Lien
(Claim of Lien)
(To be recorded in the county recorder's office in the county in which the property is located.)
NOTICE IS HEREBY GIVEN: That ________________________________ as claimant claims a lien for labor,
service, equipment, or materials under Section 8000 et Seq. of the Civil Code of the State of California, 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.
Said labor, service, equipment or materials were 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 California, said land described as follows:
STREET ADDRESS:
LEGAL DESCRIPTION:
Said lien is claimed for the following labor, services, equipment or materials: (describe labor, services,
equipment, or materials in detail)
Amount due after deducting all just credits and offsets… $___________________
The name of the person or company by whom claimant was employed or to whom claimant furnished
labor, services, equipment, or materials is:
That _____________________________________________________________________________________
_________________________________________________________________________________________
is/are the reputed owner(s) of said building and/or premises, or some interest therein.
DATED: ___________________ Name of Claimant:
By:
(Firm Name)
(Signature)
(Authorized Capacity)
VERIFICATION
I, the undersigned, certify that I am the _____________________ of the claimant named in the foregoing
Mechanics' Lien, and that I am informed and believe the facts herein to be true, and, on that ground, al-
lege that the facts stated in the foregoing Mechanics' Lien are true.
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true
and correct.
Executed on
, in the City of
, State of
.
, Its Agent
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