Fill and Sign the Dc Claim Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ____________________ Company: ____________________ Address: ____________________ City: ____________________ State: ______ Zip: ______ Phone: ____________________ Fax: ____________________ Notice of Mechanic’s Lien (D.C. Code §40-301.02) Contractor ____________________ Address ____________________________ ____________________________ Property Owner ____________________ Address ____________________________ ____________________________ BE IT NOW KNOWN that ____________________________ , having erected, improved, added to, or repaired the building owned by ____________________________ , and located at: ____________________________ , in the District of Columbia hereby gives notice that the above-described property shall be subject to a lien in the amount, less credit for payments received of ____________________________ dollars ($ __________________ ). The following work was commenced on ____________________ and completed on ____________________ : _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ This the _____ day of __________________, 20____. Notice of Mechanic’s Lien Page 1 of 2 ________________________ Signature ____________________ Printed Name District of Columbia This instrument was acknowledged before me on the ___ day of ________20__ by _____________________________ . ______________________________ (Signature of notarial officer) (Seal, if any) ________________________________________ Title (and Rank): ___________________________ (My commission expires: ______________) Notice of Mechanic’s Lien Page 2 of 2