Fill and Sign the Claim Mechanics Lien Form

Pre-Lien Notice to Owner of Intention to Claim Mechanic's Lien for Services Provided To: ________________________________ (Owner) ________________________________________________ Street Address or Post Office Box ________________________________________________ City, state, and zip code Pursuant to _______________________________________________ (statute) , notice is given that the undersigned, _________________________________________ _, (Lienholder) of ______________________________________________________________________________ __________________________________________ (street address, city, county, state, zip code) , intends to claim a mechanic's lien for $________________ on real property owned by you and located at _____________________________________________________________________ (location) , which property is more particularly described as follows: (insert legal description) ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________. The lien is claimed to secure payment of amounts due for (e.g., labor performed and materials furnished) ____________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ by the undersigned within the last ______days, pursuant to (e.g., an oral agreement or a written contract ) ____________________________________ with you dated ____________________ (date) . There is still unpaid and owing to the undersigned the sum of $_______________. Witness my signature this the ______, day of ___________________, 20______. ____________________________________ Lienholder