Fill and Sign the Affidavit Mechanics Lien Form

AFFIDAVIT FOR MECHANICS' LIEN (Corporation as Claimant) State of Ohio, County of _________________ , ss: _____________________________ , as President of _____________________________ , a ________________________ corporation, whose address is ___________________________________________________ , ___________________ , Ohio __________ , being first duly sworn, says that __________________________________ , the lien claimant, furnished certain material or performed certain labor or work in the furtherance of improvements located on or removed to the land hereinafter described, in pursuance of a certain contract, with ______________________________________ , the owner, part owner, lessee, original contractor, subcontractor, or other person, as the case may be, whose address is _______________________________________________________________________ . The first of the labor or work was performed or material was furnished on the _____ day of _______________ , 20 _______ . The last of the labor or work was performed or material was furnished on the _____ day of _______________ , 20 ______ and there is justly and truly due __________________________________ , the lien claimant, therefor from ____________________________________ , the owner, part owner, lessee, original contractor, subcontractor, or other person, as the case may be, over and above all legal setoffs, the sum of ________________ dollars, for which amount _________________________________ , the lien claimant, claims a lien on the land, building, or leasehold, of which __________________________________ is or was the owner, part owner, or lessee, as the case may be, which property is described as follows: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Description __________________________________________ Affiant _____ _____________________________________ Affidavit for Mechanics’ Lien Page 1 of 3 Type or Print Name _____ _____________________________________ Name of Corporation _____ _____________________________________ Title Attest: Secretary STATE OF OHIO COUNTY OF _____________________ Sworn to before me and subscribed in my presence this _____ day of ___________, 20 _____. _________________________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________ NOTE Section 1311.07 provides that: “Any person filing an affidavit pursuant to section 1311.06 of the Revised Code [Affidavit of Mechanic’s Lien] shall serve a copy of the affidavit on the owner, part owner, or lessee of the improved property or his designee, within thirty days after filing the affidavit. If the affidavit cannot be served in accordance with section 1311.19 of the Revised Code, then the person shall serve the copy by posting it in some conspicuous place on the premises of the improved property within ten days after the expiration of the thirty days.” This Instrument was prepared by:                         Affidavit for Mechanics’ Lien Page 2 of 3 Signature       Print or Type Name Affidavit for Mechanics’ Lien Page 3 of 3