Fill and Sign the California Notice Claim Form

Notice and Claim of Lien Page 1 of 4 CA Civil Code § 8416 Recording requested by: An d, when recorded, return to: Name: City, State, & Zip: Telephone: NOTICE AND CLAIM OF LIEN (Individual as Claimant) NOTICE OF MECHANICS LIEN ATTENTION! Upon the recording of the enclos ed MECHANICS LIEN with the county recorder's office of the county where the property is located, your property is subject to the filing of a legal action se eking a court -ordered foreclosure sale of the real property on which the lien has been recorded. That legal a ction mu st be filed with the court no later than 90 days after the date the mechanics lien is recorded. The party identified in the enclosed mechanics lien may have provided labor or materials for improvements to your property and may not have been paid for these items. Y ou are receiving this notice because it is a required step in filing a mechanics lien foreclosure action against your property. The foreclosure action will seek a sale of your property in order to pa y for unpaid labor, materials, or improvements provided to your property. This may affect y our ability to borrow against, refinance, or sell the property until the mechanics lien is released. BECAUSE THE LIEN AFFECTS YOUR PROPERTY, YOU MAY WISH TO SPEAK WITH YOUR CONTRACTOR IMMEDIATELY, OR CONTACT AN ATTORNEY, OR FOR MORE INFORMATION ON MECHANICS LIENS GO TO THE CONTRACTORS' STATE LICENSE BOARD WEB SITE AT www.cslb.ca.gov . CLAIM OF LIEN Claimant claims a mechanics’ lien on the improved real property as follows: Name of Claimant: Street Address: City, State and Zip Code: Relationship to other parties: Statement re Nature of work provided: Notice and Claim of Lien Page 2 of 4 CA Civil Code § 8416 Person/Party to whom work provided: Claimant’s Demand (less credits and offsets): Name of owner or reputed owner: Street Address: City, State and Zip Code: Name of direct contractor: Street Address: City, State and Zip Code: Name of construction lender: Street Address: City, State and Zip Code: Site of the Improvement: Street Address: City, State and Zip Code: Legal Description: I have read the foregoing CLAIM OF LIEN and know the contents thereof; the same i s true of my own knowledge. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration was executed t his day of , 20 at , California . Signature of Claimant Type or Print Name Notice and Claim of Lien Page 3 of 4 CA Civil Code § 8416 A notary public or other officer completing the certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not t he truthfulness, accuracy, or validity of that document. State of California County of On , 20 before me, (here insert name and title of the officer), personally appeared , who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same i n his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature (Seal) Notice and Claim of Lien Page 4 of 4 CA Civil Code § 8416 PROOF OF SERVICE AFFIDAVIT (Civil Code § 8416(a)(7)) I, , declare that I have served copies of the by (check appropriate box below): a. By personally delivering copies to: Name: Title: At: Street Address: City, State and Zip Code: On: , 20 , at am / pm. b. By Certified, Express, or Registered Mail Service, postage prepaid addressed to: Name: Title: At: Street Address: City, State and Zip Code: On: , 20 See attached documentation provided by the US Postal Service or express mail service showing the date of delivery and the name of the person accepting delivery; tracking record or other documentation from express carrier showing attempted delivery or delivery of the notice; or, in the event of non-delivery, the returned envelope itself. I declare under penalty of perjury that the foregoing is true and correct. Signed at , California , on , 20______ . Signature Print or Type Name ATTACH SERVICE LIST OF CERTIFIED OR REGISTERED MAIL WHEN RETURNED, OR PHOTOCOPY OF POST OFFICE RECORD OF DELIVERY OF RECEIPT. A notary public or other officer completing the certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. SWORN TO AND SUBSCRIBED before me on this the day of , 20 . Notary Public My Commission Expires: