Fill and Sign the Claim of Lien Individual 481372974 Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only--------------------- Name: _____________________ Company: ____________________ Address: _____________________ City: ______________________ State: _____ Zip: _________ Phone: _____________________ Fax: _____________________ Claim of Lien -- Individual (Idaho Code § 45-507) STATE OF IDAHO COUNTY OF ____________________ COMES NOW, ______________________________ [Lienor], and files this statement in writing within ninety (90) days after the completion of the labor or services, or furnishing of materials for improvements to the property described below, verified by the oath of ____________________________________ [Person Claiming Lien], who has personal knowledge of the facts herein set forth: 1. The undersigned hereby claims a lien upon the following property, situated in ___________________ County, Idaho, to wit: _______________________________________________________________________ [Legal Property Description]. 2. Said lien is claimed to secure an indebtedness of $________________ [Amount Claimed] with interest, after deducting all credits and offsets, from the ______ day of ________________, 20______, for _______________________________________. 3. The name of the owner or proprietor of the said property is _______________________________________________________________________. 4. If applicable, the undersigned was employed by or furnished materials to _______________________________________________________________________. This the _____ day of ________________, 20______. _____________________________Signature