Fill and Sign the Alaska Lien 497293815 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—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 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 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 1 of 3 7. Pursuant to Alaska Statute § 34.35.068 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 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 ______ . _________________________ 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 Claim of Lien Page 2 of 3 person who acknowledged). Signature of Person Taking Acknowledgment Title or Rank My Commission Expires: Serial Number, if any Claim of Lien Page 3 of 3