Fill and Sign the Fillable Online Prime Contractor Claim for Lien Form

Document NumberDocument Title Recording Area Name and Return Address Parcel Identification Number (PIN) SUBCONTRACTOR 1 CLAIM FOR LIEN- INDIVIDUAL §779.06, Wis. Stats. NOTE: This Claim for Lien must be docketed with the Clerk of Courts in the County where the Property is located. A copy of this claim must be served on the Owner of the property within thirty (30) days after filing the claim. Date: To the Clerk of Circuit Court for County, State of Wisconsin: 1. Claimant's Name: Claimant's Address: Claimant is a corporation limited liability company partnership sole proprietorship individual assignee 1 A Subcontractor is anyone who performs, furnishes, or procures labor, services, materials, plans and/or specifications to improve Owner’s property under a contract with any party except the Owner of the property being improved. See §779.02(2)(b), Wis. Stats. other: (specify) 2. Owner(s) Name(s): Owner Address: 3. Legal Description of Owner's Property improved by Claimant is:   attached to this Claim for Lien   described as: located in County, Wisconsin, and more commonly known as: (street address) 4. Description of labor, services, materials, plans or specifications performed, furnished or procured by Claimant to improve Owner's Property: under a written contract dated: other (specify): 5. Date of first visible commencement of the entire work of improvement on the Property(whether by Claimant or others): 6. Date Claimant first furnished labor or materials: 7. Date Claimant last furnished labor or materials: 8. Subcontractor’ Identification Notice was (check as applicable):  Given to Owner by hand delivery, registered mail, certified mail, or other service requiring written confirmation of receipt within sixty (60) days after first furnishing labor, services, materials, plans and/or specifications. 2 A Prime Contractor means “1. A person, other than a laborer, but including an architect, professional engineer, construction manager, surveyor, or other service provider, employed by the owner, who enters into a contract with an owner of land who is not personally the prime contractor as defined in subd. 2. to improve the land, or who takes over from a prime contractor the uncompleted contract. 2. An owner of land who acts personally as prime contractor in improving such land.” See, § 779.01(2)(d), Wis. Stats.  Not given to Owner because (check one): This was residential construction of more than a four-family building.    This was non-residential construction.    Prime Contractor 2 , or its officer(s) or controlling shareholder(s) that hired Subcontractor, hold(s) an interest in Owner's Property.   Prime Contractor that hired Subcontractor is managed or controlled by a corporation or company which owns the Property.   Claimant is a laborer or mechanic. Other: 9. Date Claimant's Notice of Intention to File Claim for Lien was given to Owner (must be at least 30 days before the filing of this Claim for Lien): 10. The Total amount owed to Claimant: $ Amount paid or otherwise satisfied to date: ($ ) AMOUNT CLAIMED $ Statement of Claim Claimant makes and files this claim for a lien upon the interest held by the Owner in the Property under Chapter 779, Wis. Stats., not more than six (6) months after Claimant last furnished labor, services, materials, plans and/or specifications as stated in Paragraph 7 above. Claimant certifies to the best of Claimant's knowledge and belief that all information contained in this Claim for Lien is correct. Based upon the above information, Claimant claims a lien upon all of the interest which the Owner has in the above described Property and improvements on it at the time of first visible commencement of the work of improvement, or that Owner may have acquired since that time, in the amount of Dollars ($ ). This claim is subject to amendment in the event foreclosure action is commenced. Claimant's Name: By: (signature) Authorized Agent's Name: (print name of person signing above) Title: Address: Telephone No: The following must be attached to this Claim for Lien:   Legal Description (unless fully set forth in Paragraph 3 above) Copy of Subcontractor’s Identification Notice Rights (unless not provided to Owner as indicated in Paragraph 8 above) Copy of Subcontractor’s Notice of Intention to File Claim for Lien This instrument was drafted by _____________. C E R TIFIC A TE O F SE R V IC E I, ________________________, do hereby certify that on (date) a true and correct copy of the above and foregoing ________________________ was served upon ______________________________ by: Personal Service Mailing a copy of the above document by certified mail, return receipt requested, to ________________________ at the following address: ________________________ ________________________ Mailing a copy of the above document by registered mail, return receipt requested, to ________________________ at the following address: ________________________ ________________________ So certified this the ______ day of ___________________, 20____. Signature Print/Type Name