Mechanic'S Lien Form - Blank
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1
2Mechanic’s Lien
Effective Date
____/____/______
The Claimant
[Legal Name], AKA (The Claimant)
Located at
[Address]
[City], [State] [Zip Code]
Claims a Mechanic’s Lien upon the following described real property:
Located at
[Address]
[City], [State] [Zip Code]
General Description of Property where work or materials were furnished:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
The sum of $__________ is the claim amount together with interest thereon at the rate of
________ percent per annum from ____/____/______, is due the above mentioned claimant
(after deducting all just credits and offsets) for the following work and materials furnished by
the claimant:
Description of the work or materials furnished:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
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