Fill and Sign the Claim of Liencorporation Form

Claim of Lien Page 1 of 3 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 Assessor’s Property Tax Parcel No./Account No. _______________________________ _______________________________, Claimant vs _______________________________, [Name of person indebted to claimant] Notice is hereby given that the person named below claims a lien pursuant to RCW 60.04. In support of this lien the following information is submitted: 1. NAME OF LIEN CLAIMANT: ____________________________ TELEPHONE NUMBER: ____________________________ ADDRESS: ____________________________ ____________________________ 2. DATE ON WHICH THE CLAIMANT BEGAN TO PERFORM LABOR, PROVIDE PROFESSIONAL SERVICES, SUPPLY MATERIAL OR EQUIPMENT OR THE DATE ON WHICH EMPLOYEE BENEFIT CONTRIBUTIONS BECAME DUE WAS THE _____ DAY OF __________________, 20______. 3. NAME OF PERSON INDEBTED TO THE CLAIMANT: _________________________________. 4. DESCRIPTION OF THE PROPERTY AGAINST WHICH A LIEN IS CLAIMED (Street address, legal description or other information that will reasonably describe the property): ___________________________________________________________________________________________________________________________________________________________________________________.
5. Name of person liable to make monthly payments of the mortgage, assessment, rent, taxes and insurance if a person is liable to make monthly payments of a mortgage or assessor. 6. 6. Date of the event giving rise to a lien or notice giving notice of a lien that is the subject and basis of this lien: 7. 7. Lien claim (corporation assessor's title to the property to be assessed):. 8. 9. 10. Claim of lien claim of lien (corporation assessor's title to the property to be assessed):. 11. Lien claimant—corporation assessor's title to the property to be assessed:. 12. Claim of lien claim (corporation assessor's title to the property to be assessed):. 13. Claim of lien claim (corporation assessor's title to the property to be assessed):. 14. Claim of lien claim (corporation assessor's title to the property to be assessed):. 15. Claim of lien claim (corporation assessor's title to the property to be assessed):. 16. Lien claimant—corporation assessor's title to the property to be assessed:. 17. Claim of lien claim (corporation assessor's title to the property to be assessed):. 18. Claim of lien claim (corporation assessor's title to the property to be assessed):. 20. Lien claimant—corporation assessor's title to the property to be assessed:. 21. Claim of lien claim (corporation assessor's title to the property to be assessed):.    property sold to the claimant: .   Propertyy not sold to the claimant: . 22. Claim for lien. Date: