Fill and Sign the Ak Corporation 497293818 Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ____________________ Company: _____________________ Address: ____________________ City: _____________________ State: _____ Zip: _________ Phone: _____________________ Fax: ___________________ CLAIM OF LIEN—CORPORATION, LLC, etc. (A.S. § 34.35.070) COMES NOW, _________________________________ , as a representative of _________________________________ a _________________________________ company which has furnished labor, material, services, or equipment for the improvement of the property legally described as _____________________________________________________________ and being entitled to a lien thereby would state as follows: 1. The above-described property is owned by __________________________________ . 2. The undersigned corporate claimant, __________________________________ , may be reached at the following address: ___________________________________ . 3. The undersigned has furnished labor, services, material, or equipment through a contract with _________________________________ . 4. The following is a general description of the labor, materials, services, or equipment furnished, including the contract price: _________________________________ . 5. The undersigned corporate lien claimant is currently due the amount of $ ______________ for labor, material, services, or equipment furnished. 6. The undersigned last furnished said labor, material, services, or equipment on or about the ____ day of _____________ , 20 ______ . 7. Pursuant to Alaska Statute § 34.35.068 the undersigned lien claimant has recorded this Claim of Lien either Claim of Lien Page 1 of 3 ( ) Within ninety (90) days of the completion of the construction contract; or ceasing to furnish labor, material, services, or equipment for the construction, alteration, or repair of the owner’s property. ( ) Within fifteen (15) days after the property owner has recorded a Notice of Completion. This the _____ day of _________________ , 20 ______ . _________________________ Name of Corporation By: __________________________ ______ _ _____ Signature Title _________________________ Type or Print Name Attest: Secretary State of Alaska _______________________ Judicial District _________________________ Claimant I, ___________________________________, being first duly sworn, on oath say that I am _________________________ named in the foregoing claim; that I have heard the claim read, know the contents of it, and believe it is true. _________________________ Signature _________________________ Print or Type Name State of _________________________ Judicial District (or County) of _____________________ or Municipality of _________________________ The foregoing instrument was acknowledged before me this _____________ (date) by _________________________ (name of officer or agent, title of officer or agent) of (name of company acknowledging) a _________________________ (state or place of incorporation) company, on behalf of the company. Claim of Lien Page 2 of 3 Signature of Person Taking Acknowledgment Title or Rank Serial Number, if any My Commission Expires: __________________ Claim of Lien Page 3 of 3