Claim Of Lien - State Of Florida
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1WARNING!
This space for recorder use only.
THIS LEGAL DOCUMENT REFLECTS THAT A CONSTRUCTION
LIEN HAS BEEN PLACED ON THE REAL PROPERTY LISTED
HEREIN. UNLESS THE OWNER OF SUCH PROPERTY TAKES
ACTION TO SHORTEN THE TIME PERIOD, THIS LIEN MAY
REMAIN VALID FOR ONE YEAR FROM THE DATE OF
RECORDING, AND SHALL EXPIRE AND BECOME NULL AND
VOID THEREAFTER UNLESS LEGAL PROCEEDINGS HAVE BEEN
COMMENCED TO FORECLOSE OR TO DISCHARGE THIS LIEN.
Claim of Lien
State of ___________________________
County of ___________________________
Before me, the undersigned notary public, personally appeared ____________________________________________,
who was duly sworn and says that she or he is (check one)
_____the lienor herein; or _____ the agent of the lienor herein ____________________________________________,
whose address is ________________________________________________________________________________,
and that in accordance with a contract with ____________________________________________________________,
lienor furnished labor, services, or materials consisting of __________________________________________________
on the following described property in _____________________________ County, Florida:
(Legal description of real property)
owned by ________________________________________________________ of a total value of $________________,
of which there remains unpaid $___________________, and furnished the first of the items on ____________________,
20______; and (if the lien is claimed by one not in privity with the owner) that the lienor served her or his notice to owner
on ________________________, 20______ by ________________________________________; and (if required) that
the lienor served copies of the notice on the contractor on ______________________________, 20_____, by
________________________________________________________________________ and on the subcontractor,
_____________________________________________________________, on ___________________, 20______, by
_____________________________________________________________.
__________________________________________________
Signature
Sworn to (or affirmed) and subscribed before me this ___________ day of __________________________, 20_____, by
______________________________________________.
__________________________________________________
NOTARY PUBLIC - STATE OF FLORIDA
Personally known ________ or Produced Identification ________
Type of ID Produced ___________________________________
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