Fill and Sign the Al Lien Form

Prepared by:       After Recording, Return to:       (Full Name of Party)       (Company, if applicable)       (Street Address)       (City, State and Zip Code) Notice of Lien for Furnishing of Materials - Individual (Ala.Code. § 35-11-210) To the Owner or Proprietor:       (name of owner or proprietor)       (Street Address)       (City, State, Zip Code) TAKE NOTICE , that the undersigned is about to furnish:       (name of contractor / subcontractor)       (Street Address)       (City, State, Zip Code) your contractor or subcontractor, certain material for the construction, or for the repairing, altering, or beautifying of a building or buildings, or improvement or improvements, on the following described property: See Legal Description Attached as Exhibit A incorporated by reference as though set forth in full Legal Description:       Notice of Lien for Furnishing of Materials – Individual Page 1 of 3 and there will become due to the undersigned on account thereof the price of the material, for the payment of which the undersigned will claim a lien. Date:       (Signature)       (Print or Type Name)       (Street Address)       (City, State, Zip Code) Certificate of Delivery I,       , hereby certify that I have delivered this day a true and correct copy of the foregoing to       by: Personal Service with signed receipt Mailing a true and correct copy of same by first-class U.S. mail, postage prepaid, return signed receipt requested to:       (Name)       (Street Address)       (City, County, State, Zip Code) Other (specify)       So certified this the       day of       , 20       . (Signature)       (Type or Print Name) Notice of Lien for Furnishing of Materials – Individual Page 2 of 3 NOTICE OF NON-RESPONSIBILITY: Pursuant to Alabama Code § 35-11-210, the undersigned property owner, proprietor, or agent thereof, hereby provides notice to the above named furnisher of materials that said property owner or proprietor will not be responsible for the price of materials furnished.       (name of owner or proprietor or agent)       (Street Address)       (City, State, Zip Code) Certificate of Delivery Notice of Non-Responsibility I,       , hereby certify that I have delivered this day a true and correct copy of the foregoing to       by: Personal Service with signed receipt Mailing a true and correct copy of same by first-class U.S. mail, postage prepaid, return signed receipt requested to:       (Name)       (Street Address)       (City, County, State, Zip Code) Other (specify)       So certified this the       day of       , 20       . (Name)       (Type or Print Name) Notice of Lien for Furnishing of Materials – Individual Page 3 of 3