Fill and Sign the Demand for Filing Claim of Lien to Potential Lien Claimant Form

Demand for Filing Claim of Lien Page 1 of 3DEMAND FOR FILING CLAIM OF LIEN TO POTENTIAL LIEN CLAIMANT ON RESIDENTIAL PROPERTY - INDIVIDUAL TO:________________________________ ________________________________ ________________________________ ________________________________ 1.A Preliminary Lien Notice was filed with the Clerk of Superior Court of the County in which the subject real estate is located within 30 days after the Claimant: ( ) delivered materials ( ) provided any labor or services, for which a lien may be claimed. (check all that apply) 2.The name, address, and telephone number of the potentiallien claimant are:_________________________________________ _________________________________________ _________________________________________ _________________________________________ 3.The name and address of the contractor or other person at whose instance the labor, services, or materials were furnished is/are:________________________________________ ________________________________________ ________________________________________________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ 4.The name of the owner of the real estate is: __________________________________.5.A description sufficient to identify the real estate against whichthe lien is or may be claimed is:________________________________________. 6.A general description of the labor, services, or materials furnished or to be furnished is as follows: Demand for Filing Claim of Lien Page 2 of 3____________________________________________________________ ____________________________________________________________ 7. The property is located in _____________________ County, Georgia and has a common address of ___________________________________________________________8.This demand was mailed to you on ____________________________ pursuant to Code Section 44-14-361.4. You are notified that unless you file a claim of lien with respect to this claim on or before the tenth day after said date of mailing your right to claim a lien will be dissolved. 9.A true and correct copy of the Preliminary Lien Notice filed by you is attached hereto as Exhibit "A." 10.Please take notice that the preliminary notice of lien rights filed by you dated _________________________________ shall expire and be dissolved if at least ten days have elapsed since the date of this mailing and you have not filed a claim of lien.DATED this the _____ day of ____________________, 20_____. ____________________________________ Signature____________________________________Type or Print Name Demand for Filing Claim of Lien Page 3 of 3 Affidavit of Service State of ________________County of ____________________I, ________________________________, hereby certify that I have this date sent a true and correct copy of this ______________________________________ by certified mail, return receipt requested, registered mail, return receipt requested, statutory overnight delivery, acknowledging delivery signed by addressee or agent of addressee requested, in accordance with law, to the potential lien claimant specified in the preliminary notice of lien rights, which the name and address are as follows: __________________________________ __________________________________ ____________________________________________________________________ DATED this the ______ day of __________________, 20______. _____________________________Signature _____________________________ Type or Print Name Reference 44-14-361.4.