Claim Of Mechanic's Lien





I, the undersigned, whose address is __________________________________, affirm that in accordance with a contract between myself and _________________________, I furnished labor, services or materials consisting of:


of a total value of ____________________ Dollars ($ ) of which there remains unpaid amount of _________________ Dollars ($ ), on the following described real property located at ________________________________ in _____________ County, State of _____________________:

which is owned by ___________________. I furnished the first of the labor, service, or materials on the ____ day of _______________, 20__ .

Notice of this Claim have been served on:

__________________________________ by _____________________________ at ____________________________________ on _________________________.

__________________________________ by _____________________________ at ____________________________________ on _________________________.






Subscribed and sworn before me on this ___ day of ___________, 20__.

WITNESS my hand and seal.

____________________________________ My commission expires:

Notary public




These forms are provided AS IS. They may not be any good. Even if they are good in one jurisdiction, they may not work in another. And the facts of your situation may make these forms inappropriate for you. They are for informational purposes only, and you should consult an attorney before using them.

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