Claim Of Lien

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Claim of Lien
Notice is hereby given that on ____/____/______
The Claimant
[Legal Name], AKA (The Claimant)
Located at
[Address]
[City], [State] [Zip Code]
First provided labor or material for an improvement to:
Owner
[Legal Name]
Located at
[Address]
[City], [State] [Zip Code]
General Description of Property where work or materials were furnished:
_____________________________________________________________________________
_____________________________________________________________________________
The final day of providing labor or material was on ____/____/______.
Contractors:
The lien claimant’s amount is $__________. The lien claimant has received payment in total of
$__________ and therefore claims a construction lien upon the above specified real property in
the amount of $__________.
Laborers:
The lien claimant’s rate that is charged by the hour is $__________. For the labor there is a sum
of $__________ and the lien claimant claims a construction lien upon the above described real
property.
__________________________________________________________
Date____________
Signature of Lien Claimant
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