Fill and Sign the Claim of Lien Corporation 490206127 Form

Claim of Lien Page 1 of 2 Prepared by, recording requested by and return to: Name: __________________ Company: ____________________ Address: ____________________ City: ____________________ State: _____ Zip: __________ Phone: __________________ Fax: ____________________ ----------------------Above this Line for Official Use Only--------------------- CLAIM OF LIEN – CORPORATION (Okla. Stat. Ann. §42-142) COMES NOW, _________________________________, as a representative of __________________________________ a ________________________________ corporation providing labor and/or materials for the improvement of the property located at and described as _______________________________________________________________________________________________________________________________________________. 1. The undersigned began providing labor and/or materials for the improvement of the above-described property on or about the _____ day of ________________, 20______, and last furnished labor and/or materials on or about the _____ day of ________________, 20______. 2. Said property is owned by ________________________________. 3. The contractor primarily responsible for the improvement of said property is __________________________________. 4. The undersigned provided the following labor and/or materials: Labor/Materials Date Cost/Value ________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Claim of Lien Page 2 of 2 ________________________________________________________________________ _______________________________________________________________________. 5. The undersigned would hereby claim a lien against said property in the amount of $ _______________. This the _____ day of _________________, 20______. ______________________________ Signature______________________________ Type or Print Name______________________________ Title______________________________ Corporation Attest: Secretary Verification by Affidavit: State of Oklahoma County of __________________ ____________________________________, of lawful age, being first duly sworn, upon oath, says: The he/she is the claimant mentioned in the foregoing statement of mechanic’s lien; that he/she had read said statement and knows the contents thereof; that the name of the owner, the name of the contractor, the name of the claimant, the description of the property upon which the lien is claimed, and the items of the account as therein set forth, are just, true and correct. Subscribed and sworn to before me this ______ day of __________________, 20______. Notary Public My Commission expires: My Commission Number: