Fill and Sign the 9104 Notice and Form Requirements for Liens View Document

Notice to Owner or Owner’s Agent of Intention to Claim a Lien Page 1 of 2 Notice to Owner or Owner’s Agent of Intention to Claim a Lien -- Corporation (Md. Code Ann. §9-104) 1. _________________________________ (Name of Subcontractor or Company) did work or furnished material for or about the building generally designated or briefly described as: _______________________________________________________________________________________________________________________________________________. 2. The total amount earned under the subcontractor's undertaking to the date hereof is $_________________ of which $_________________ is due and unpaid as of the date hereof. 3. The work done or materials provided under the subcontract were as follows: (insert brief description of the work done and materials furnished, the time when the work was done or the materials furnished, and the name of the person for whom the work was done or to whom the materials were furnished). Work Done/Materials Furnished Date Name ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ I do solemnly declare and affirm under the penalties of perjury that the contents of the foregoing notice are true to the best of the affiant's knowledge, information, and belief. _____________________________Affiant ______________________________ On Behalf Of ______________________________ Type or Print Name
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