Fill and Sign the Hawaii Lien Form

IN THE CIRCUIT COURT OF THE ________________ CIRCUIT STATE OF HAWAII __________________________________ M.L. No. ______________ LIENOR VS. APPLICATION FOR MECHANIC’S AND MATERIALMAN’S LIEN ___________________________________ RESPONDENT(S) APPLICATION OF MECHANIC’S AND MATERIALMAN’S LIEN NOTICE IS HEREBY GIVEN that ________________________________ as a lienor, applies for a mechanic’s and materialman’s lien based on the facts set forth in the attached Notice of Lien and under the provisions of Chapter 507, Part II, of the Hawaii Revised Statutes (“HRS”), as amended, on the property located at and described as _______________________________________________________________________ , for improvements described as _______________________________________________________________________ , in the principal amount of $ ________________ , or such reasonable amount to be proven to the Court, plus interest, together with attorney’s fees as authorized by HRS Chapter 507, and court costs, and such other relief as this Court deems just and proper. The parties to the contract for the above-described improvements are _______________________________________________________________________ . The name of the general contractor is __________________________________ , the name of the owner(s) of the property is/are __________________________________ , and any other person with an interest is __________________________________ . Dated: __________________ , Hawaii, _____ day of _________ , 20 ______ . ____________________________ Signature _____ _______________________ Type or Print Name Capacity _____ ________________ Application of Mechanic’s and Materialman’s Lien Page 1 of 1