Fill and Sign the Alaska Lien Form

Claim of Lien Page 1 of 3 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 — INDIVIDUAL (A.S. § 34.35.070) COMES NOW, ________________________________ , as a party 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 claimant, _________________________________ , may be reached at the following address: ________________________________ . 3. The undersigned has furnished labor, services, material, or equipment thr ough 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 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 _______ . Claim of Lien Page 2 of 3 7. Pursuant to Alaska Statute § 34.35.0 68 the undersigned lien claimant has recorded this Claim of Lien either ( ) Within ninety (90) days of the completion of the construction contract; or ceasing to furnish labor, material, services, or equ ipment 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 _____ _. _________________________ Signature _______ _________________ __ Print or Type Name 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 person who acknowledged). Claim of Lien Page 3 of 3 Signature of Person Taking Acknowledgment Title or Rank My Commission Expires: Serial Number, if any