Fill and Sign the Assignment of Lien Individual Florida Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ___________________ Company: ___________________ Address: _____________________ City: __________________________ State: _____ Zip: _____________ Phone: _____________________ Fax: _______________________ ASSIGNMENT OF LIEN- INDIVIDUAL Beginning on or about the _____ of _______________ , 20 _____ , the undersigned lien claimant, __________________________________ , furnished or supplied labor, materials, or laborers to ___________________________________ for the purpose of improvements of real property at _________________________________________________________________ , such that the undersigned lien claimant is entitled to a lien for the value of labor, materials, or laborers supplied. Notice is hereby given that pursuant to Section 713.19, Florida Statutes , the above- mentioned lien claimant does hereby assign his or her claim and lien to ___________________________________ , who shall hereafter have all the rights and remedies under law to which the lien claimant is entitled for the purpose of filing and for the enforcement of the above-mentioned lien. This the _____ day of ____________ , 20 _____ . ____________________________ (signature of lienor) _____ ________________________ Type or Print Name Assignment of Lien Page 1 of 2 _____ _______________________ _____ _______________________ (address of lienor) STATE OF ___________ COUNTY OF _____________ Sworn to (or affirmed) and subscribed before me this _____ day of _________________, 20______ by _________________________ (name of person making statement) who is personally known to me or produced _________________________ as identification, and who did take an oath. ____________________________ NOTARY PUBLIC Printed Name of Notary _________________________ Commission Expires _________________________ Certificate of Service I, _____________________________________, hereby certify that I have delivered this day a true and attested copy of the foregoing to ___________________________________ by: ( ) Actual Delivery to the person to be served. ( ) Mailing a true and correct copy of same by registered or certified U.S. mail, with postage prepaid, or by overnight or second-day delivery with evidence of delivery. ( ) If service cannot be made by the above methods, by posting on the premises. ________________________ Signature Assignment of Lien Page 2 of 2