Fill and Sign the Georgia Request Record Form

Prepared by, recording requested by and return to: Name __________________________ Company ________________________ Address ____________________________ City ________________________________ State ________ Zip ______________ Phone ____________________ ------------------------------------Above this line for Official Use Only ----------------------------------- OBJECTION TO REQUEST THAT CLERK MARK LIEN VOID OF RECORD - CORPORATION TO: Clerk, Superior Court of ________________ County, Georgia The undersigned _________________________________________ , as the lien claimant on the construction of improvements to real property described as _____________________________________ hereby objects to the request by _________________________________ , as owner of the property located at ________________________________________________________ that the lien filed on the above property be marked void of record filed on _____ day of ______________ , 20 _____ and states the following: 1. As certified in the attached affidavit, a Notice of Action has been filed with the clerk of the superior court as required by O.C.G.A. Section 44- 14-361.1 within 14 months from the time the claim became due. 2. The undersigned lien claimant files this written objection within 30 days from the date of the filing of the request with the superior court clerk on the basis that the proper notice was timely filed. 3. Pursuant to O.C.G.A. Section 44-14-367(a) and upon filing of this objection, the clerk shall not mark the lien void and the parties must seek relief in the superior court through a declaratory judgment action. This _____ day of __________________ , ___________ . _________________________________ Signature of Lien Claimant _____ ____________________________ Type or Print Name _____ ____________________________ Title _____ ____________________________ Name of Corporation Objection to Request that Clerk Mark Lien Void of Record Page 1 of 4 Attest: Secretary 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 owner, which the name and address are as follows: __________________________________ __________________________________ __________________________________ __________________________________ DATED this the ______ day of __________________ , 20 ______ . _____________________________ Signature _____ ________________________ Type or Print Name Objection to Request that Clerk Mark Lien Void of Record Page 2 of 4 Affidavit Certifying Filing of Notice of Action STATE OF GEORGIA COUNTY OF ______________________ BE IT KNOWN THAT _________________________________ , an attorney licensed to practice law in Georgia, upon being duly sworn, states on oath the following: 1. The undersigned attorney has searched the superior court records in the county in which the subject property is located. 2. According to information received from the superior court clerk's office the indexes of real property transactions are current through a date more than 12 months from the date the lien claimant's claim became due. 3. The superior court records reflect that a Notice of Action was filed as is required by O.C.G.A. Section 44-14-361.1 on _____ day of _______________ , 20 _____ . WITNESS my signature this the _____ day of __________________ , 20 _____ . __________________________________________ Signature Printed Name: _________________________ Sworn to (or affirmed) and subscribed before me this ____ day of __________ (month), __________ (year), by _______________________ (name of person making statement). _______ Personally Known _______ Produced Identification Type and # of ID __________________________ ____________________________ (Signature of Notary) (Seal) _____________________________ (Name of Notary Typed, Stamped or Printed) Notary Public, State of Georgia My Commission Expires: ______________ Reference: 44 - 14 - 367. Objection to Request that Clerk Mark Lien Void of Record Page 3 of 4 Objection to Request that Clerk Mark Lien Void of Record Page 4 of 4