Fill and Sign the Artisans Lien Form

Notice of an Artisan’s Common Law Lien To: ____________________________________________________________ Street Address or Post Office Box______________________________________ City, state, and zip code ______________________________________________ Notice is hereby given that ___________________________________________, the undersigned artisan, who resides at ________________________________________ __________________________________________________________________ (street address, city, county, state, zip code) , claims a lien on the following described property ( hereinafter called Property) : (Describe Property) _______________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ In order to perfect such lien, the undersigned submits the following account of labor performed and materials supplied: 1. On ___________________ (date) , the undersigned, pursuant to ______________ __________________________ (a written or an oral) agreement with you, expended labor and materials on said Property owned by you. 2. The labor performed consisted of ______________________________________ ________________________________________________________________________ __________________________________________________________ (describe labor) , and materials and/or parts. The parts and/or materials and their prices are listed as follows: Item(s) Price _________________________________________ _____________ _________________________________________ _____________ _________________________________________ _____________ ________________________________________ _____________ _________________________________________ _____________ _________________________________________ _____________ 3. The undersigned claims a lien on the above-described property in the amount of $_____________, which represents the agreed value for the labor performed and the materials furnished for which the undersigned has not received payment . 4. No part of the $____________ set forth above has been paid by you, as owner, to the undersigned, which, after all just offsets, leaves an unpaid balance of $____________ still due and owing to the undersigned. Witness my signature this the _____, day of ____________________, 20____. ____________________________________ Lienholder