Fill and Sign the Alaska Lien 497293745 Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ____________________ Company: ___________________ Address: _____________________ City: _______________________ State: ________ Zip: _________ Phone: ___________________ Fax: _____________________ NOTICE OF A RIGHT TO A LIEN- INDIVIDUAL (A.S. § 34.35.064) COMES NOW, _________________________________ , whose address is __________________________________ , as a party who will furnish labor, material, service, or equipment and would hereby provide Notice of the following: 1. This is a notice of a right to assert a lien against real property for labor, materials, services, or equipment furnished in connection with a project. 2. The undersigned will furnish labor, material, services, or equipment for the improvement of the property located at and legally described as: ____________________________________________________________________________ . 3. Said property is owned by _________________________________ . 4. The undersigned contracted to furnish labor, material, services, or equipment with __________________________________ of the following address: _________________________________ . 5. The following is a general description of the labor, material, services, or equipment provided or to be provided: ____________________________________ . 6. The undersigned would hereby provide Notice that the undersigned may be entitled to record a claim of lien as a result of the furnishing of the above-mentioned labor, material, services, or equipment. Notice of a Right to a Lien Page 1 of 2 WARNING: Unless provision is made for payment of sums that may be due to the undersigned, your above property may be subject to foreclosure to satisfy those sums even though you may pay a prime contractor or other person for the labor, material, service, or equipment furnished by the undersigned. This the _____ day of _____________ , 20 ______ . _________________________________________ Signature _____ _____________________________________ Type or Print Name 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 ___________________________, So certified this the ______ day of ___________________, 20____. ________________________ Signature Notice of a Right to a Lien Page 2 of 2