Fill and Sign the Condominium Unit Owner Form

Notice of Lien to a Condominium Unit Owner for Unpaid Assessment Fees Notice is hereby given that the undersigned ____________________________________ _____________________________________________________ (e.g., Name of Condominium Association) , whose mailing address is ______________________________________________ ______________________________________________________________________________ ______________________________________________________ (Post Office Box Number or Street Address, City, State, Zip Code) hereby claims and intends to hold and claim a lien upon that certain Condominium Unit and interest in common areas owned by ____________________ __________________________________________________________ (Name of Unit Owner) situated in ____________________________________________________________________ (Name of County and State) , being more particularly described as follows: (Insert Legal Description) __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ The purpose of this lien is to secure payment of assessments in the sum of $___________ due on ___________________________________________ (Date) and owing to the undersigned ___________________________________________________________________ ________________________ (e.g., Name of Condominium Association) . The total amount due as of _____________________________________ (Date) is $___________________ and there will be additional charges for collection fees and ongoing maintenance. Said indebtedness accrued and the undersigned furnished services pursuant to the ____________________________________________________________________________________________________ (e.g., Declaration of Condominium) and any amendments thereto filed by the ____________________________________________________________________ __________________________________________ (e.g., Name of Condominium Association) in Book _____ at Page _____ of the ________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________ (County official’s name and office where Deeds are recorded), which obligation was assumed by said owner as a condition of ownership in the aforesaid condominium for which said owner did by acceptance agree to pay the lien of such assessments as they become due in accordance with the aforesaid Declaration. WITNESS our signature this the ____ day of _______________________________, 20____. __________________________________________ (Name of Condominium Association) By_______________________________________ __________________________________________ (Name and Office in Association) STATE OF _________________________________________________ COUNTY OF __________________________________ Personally appeared before me, the undersigned authority in and for said County and State, on this _______________________________________ (Date), within my jurisdiction, the within named __________________________________________________ (Name of Officer), who acknowledged that he is the ___________________________________________________ (Name of Office) , of ____________________________________________________________ (name of corporation) , a ___________________________________________________ (name of state) corporation, and that he executed the above and foregoing instrument for and on behalf of said corporation, after being duly authorized so to do. ____________________________________ NOTARY PUBLIC My Commission Expires:_______________________________ Note: (Form of acknowledgement/oath may vary from state to state)