Mechanic Lien

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Notice of Mechanic Lien

**TO WHOM IT MAY CONCERN:**

Please take notice that pursuant to the laws of this jurisdiction concerning mechanic's liens, the undersigned, {{claimant_name}} (hereinafter “Claimant”), hereby claims a lien upon the property described below for labor, services, or materials furnished for the improvement of said property.

Parties Involved

**Claimant Information:**

Name: {{claimant_name}}

Address: {{claimant_address}}

Phone: {{claimant_phone}}

**Property Owner Information:**

Name: {{owner_name}}

Address: {{owner_address}}

**Contractor/Subcontractor (if applicable):**

Name: {{contractor_name}}

Address: {{contractor_address}}

Property Description

The property upon which the work was performed or materials were supplied is legally described as follows:

{{property_legal_description}}

Physical Address: {{property_physical_address}}

Description of Labor, Services, or Materials

The Claimant furnished the following labor, services, or materials for the improvement of the above-described property:

{{description_of_work_materials}}

The date the first work was performed/materials supplied: {{first_work_date}}

The date the last work was performed/materials supplied: {{last_work_date}}

Amount Claimed

The total amount due and owing to the Claimant for the aforementioned labor, services, or materials is: {{currency}} {{amount_due}} ({{amount_due_words}}).

This amount includes (if applicable):

- Original contract amount: {{currency}} {{original_contract_amount}}

- Extra work/change orders: {{currency}} {{extra_work_amount}}

- Materials supplied: {{currency}} {{materials_amount}}

- Less payments received: {{currency}} {{payments_received}}

Statement of Account

An itemized statement of the account showing the dates and amounts of charges for labor, services, or materials furnished, and the dates and amounts of all payments made, is attached hereto as Schedule A (if applicable) and incorporated herein by reference.

Declaration

I, the undersigned, being the Claimant or an authorized representative thereof, do hereby declare under penalty of perjury that the foregoing statements are true and correct to the best of my knowledge and belief.

Demand for Payment

Demand is hereby made for immediate payment of the outstanding amount. Failure to make full payment within {{days_notice}} days may result in further legal action to enforce this lien.

Signature Block

DATED this {{day}} day of {{month}}, {{year}}.

_____________________________

{{claimant_signature}}

{{claimant_printed_name}}

Title: {{claimant_title}}

WITNESSES:

1. _____________________________

{{witness_1_name}}

2. _____________________________

{{witness_2_name}}

ACKNOWLEDGEMENT (Notary Public):

On this {{notary_day}} day of {{notary_month}}, {{notary_year}}, before me, a Notary Public in and for said County and State, personally appeared {{claimant_printed_name}}, known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged that he/she executed the same for the purposes therein contained.

_____________________________

Notary Public Signature

Printed Name: {{notary_printed_name}}

My Commission Expires: {{notary_commission_expiry}}