Fill and Sign the Charging Lien Form

Notice of Charging Lien on a Judgment; Attorney’s Notice of Intent to File Lien To: ________________________ (Name of Defendant) , Defendant, and Defendant's attorney of record, _______________________ (Name of Attorney of Record) , ______________________________________________________ _______________________________ (Street Address, City, State, Zip Code) : You are notified that I, the undersigned _____________________ (Name of Attorney Claiming Lien) , as attorney for _____________________ (Name of Client) , claim a lien on the judgment rendered in the action filed on _________________ (date) in the __________________ (Name of Court) of _____________________ (Name of County) , __________________ (Name of State) , entitled _____________________ (Name of Plaintiff) v. ___________________ (Name of Defendant) , Cause Number ________________, and on all money due from Defendant and owing by Defendant on the judgment made and entered on _________________ (date) . My above-described lien on the judgment and money is for my legal services rendered to ________________ (Name of Plaintiff) in the action described above and in all subsequent actions and proceedings brought for the purpose of compelling the payment of the amount due on the judgment. The undersigned intends to file with the county recorder a lien statement regarding the above mentioned judgment within ten (10) days from the date of service of this Notice. Witness my signature this the _____ day of _____________, 20____. ____________________________ (Printed Name of Attorney) ____________________________ (Signature of Attorney) Certificate of Delivery I, __________________ (Name of Attorney) , hereby certify that I have delivered this day a true and correct copy of the foregoing to _____________________ (Name of Defendant) , Defendant, and Defendant's attorney of record, ______________________ (Name of Attorney of Record) , ____________________________________________ ___________________________ (Street Address, City, State, Zip Code) by: ( ) Personal Service ( ) Mailing a true and correct copy of same by registered or certified U.S. mail, postage prepaid, return receipt requested to ____________________ (Name of Defendant) , at __________________________________________________________ _____________ (Defendant’s Address) and the Attorney for Defendant __________________________ (Name of Attorney for Defendant) , at ____________ ___________________________________________________ (Attorney’s Address) . ____________________________ (Printed Name of Attorney) ____________________________ (Signature of Attorney) State of __________________ County of ____________ Subscribed and affirmed, or sworn to before me in the County of _________, State of ______________, this _______, day of ________________, 20 ____. _______________________________ Notary Public My Commission Expires: ____________________