Amended Notice of Unpaid Balance and Right to File Lien

AMENDED NOTICE OF UNPAID BALANCE AND RIGHT TO FILE LIEN--CORPORATION--RESIDENTIAL

TO THE CLERK, COUNTY OF

In accordance with the terms and provisions of the "Construction Lien Law," P.L.1993,
c.318 (C.2A:44A-1 et al.), an amended notice is hereby given that:

1. of

() has on the day of , a potential
construction lien against the below described property of

, in the amount of $
for the value of the work, services, material or equipment provided in accordance with a contract with

for the following work, services, materials or equipment:

a.

b.

c.

2. The amount due for work, services, materials or equipment provided by claimant in
connection with the improvement of the real property, and upon which this lien claim is
based is as follows:

3. This construction lien is to be claimed against the interest of
as: Owner, Lessor or Other: in that certain tract or parcel of land

and premises described as Block , Lot , on the tax map of
the County of , State of New Jersey, for the improvement of which
property the aforementioned work, services, materials or equipment was provided.

4. The work, services, materials or equipment was provided pursuant to the terms of a
written contract (or, in the case of a supplier, a delivery or order slip signed by the owner,
contractor, or subcontractor having a direct contractual relation with a contractor, or an
authorized agent of any of them), dated the day of
between and of

().

5. The date of the provision of the last work, services, material or equipment for which
payment is claimed is the day of .

6. The written contract is is not a residential construction contract as defined in
section 2 of this act.

7. This notification has been filed prior or subsequent to completion of the work,
services, materials or equipment as described above. The purpose of this notification is
to advise the owner and any other person who is attempting to encumber or take transfer
of said property described above that a potential construction lien may be filed within the
90 day period following the date of the provision of the last work, services, materials or
equipment as set forth in paragraph 5.

CLAIMANT'S REPRESENTATION AND VERIFICATION

Claimant represents and verifies that:

1. The amount claimed herein is due and owing at the date of filing, pursuant to
claimant's contract described in the Amended Notice of Unpaid Balance and Right to File
Lien.

2. The work, services, material or equipment for which this Amended Notice of Unpaid
Balance and Right to File Lien is filed was provided exclusively in connection with the
improvement of the real property which is the subject of this Amended Notice of Unpaid
Balance and Right to File Lien.

3. The Amended Notice of Unpaid Balance and Right to File Lien has been filed within
90 days from the last date upon which the work, services, materials or equipment for
which payment is claimed was provided.

4. The foregoing statements made by me are true, to the best of my
knowledge.

This the day of

Acknowledgment of Corporation

State of New Jersey, County of , ss:

I CERTIFY that on , personally came before me and this person
acknowledged under oath, to my satisfaction, that:

(a) this person is the of the corporation named in this
document;

(b) this document was signed and delivered by the corporation as its voluntary act duly
authorized by a proper resolution of its Board of Directors;

(c) this person knows the proper seal of the corporation which was affixed to this
document; and

(d) this person signed this proof to attest to the truth of these facts.

Signed and sworn to before me on

My commission expires:

NJ § 2A: 44A-20