Fill and Sign the General Form Contractor

General Form of Claim or Notice of Lien By General Contractor STATE OF ________________________________________COUNTY OF _________________________PERSONALLY appeared before me, the undersigned authority in and for said county and state, __________________________________________ (Contractor), who, having been being first duty sworn by the undersigned Notary Public, deposes and says that:1. He is _________________________________ (e.g., president), of ___________ _______________________________________________ (Company), a corporation organized under the laws of the State of _______________________________________ (name of state), with its principal office at _____________________________________ ___________________________________________________________________________________________________________ (street address, city, county, state, zip code), hereinafter called Company, and makes the following statement under _______________ _________________________________ (cite state statute) for a mechanic's lien for ________________________________________________________________________________________________________________________________________________ __________________________________________________ (e.g., materials, labor and services furnished and performed) on the following described property now owned by _______________________________________________ (Owner) of ______________ ________________________________________________________________________ ________________________________________________________________________ ___________________________________ (street address, city, county, state, zip code), said property being more particularly described as follows: (Legal Description of Property) 2. On ____________________________ (date), Company made a written contract with Owner to ___________________________________________________________ __________________________________________________________________________________________________________________________ (briefly describe contract) on the real property described above.3.Under the contract identified above, Company was to complete the work and completely perform the contract on or before _____________________________ (date); that Owner agreed to pay Company $______________, with the final payment to be made _______________________ (date); and Company did complete the work and complete performance of the contract on the ______________________________ (date).4.During the period of the work required by the contract, at the special request of Owner, Company _________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ (state what contractor did and/or describe materials furnished on and for the owner's property), with a value of $___________________.5.All of the materials furnished, labor performed and services rendered were used in and about _______________________________________________________________ ________________________________________________________________________________________________________________________________________________ (e.g., the erection or improvement of the building) on the property. The first of these materials, labor, and services was so furnished on __________________________ (date) , and the last of the same was so furnished on ______________________________ (date).6.That there is now justly due and owing to Company for the __________________ ________________________________________________________________________ ______________________________________________________________________________________ (e.g., furnishing of the materials, labor, and services), after allowing all just credits, deductions, and setoffs $____________, all of which is still due and unpaid; and Company claims a lien upon the real property identified above and upon the improvements thereon for the amount of Company’s claim of $______________ according to the statutes that apply to this matter.In witness whereof, the above-mentioned corporation has caused this instrument to be executed in its behalf, pursuant to authority of its board of directors, by _________________________________________ (Contractor), its ______________________________________ (e.g., President), and its corporate seal to be attached and attested by _____________________________________ (Witness), its _____________________________________ (e.g., secretary), on the _____ day of _______________________________, 20____.____________________________________ Company By:_________________________________Contractor, ____________________ (title)Attested to By: (Corporate seal) ___________________________________Witness Sworn to and subscribed before me, this the ____ day of ___________________, 20____. ______________________________ NOTARY PUBLICMy Commission Expires:______________________