Fill and Sign the ID Lien Form

Prepared by, recording requested by and return to: Name: ______________________ Company: ___________________ Address: ______________________ City: ____________________ State: _____ Zip: __________ Phone: _______________________ Fax: ________________________ ----------------------Above this Line for Official Use Only--------------------- Claim of Lien -- Corporation(Idaho Code § 45-507) STATE OF IDAHO COUNTY OF __________________ COMES NOW, ________________________________ as a representative of _______________________________ a _________________________________ corporation [Lienor], and files this statement in writing within ninety (90) days after the completion of the labor or services, or furnishing of materials for improvements to the property described below, verified by the oath of ________________________________ [Person Claiming Lien], who has personal knowledge of the facts herein set forth: 1. The undersigned hereby claims a lien upon the following property, situated in ___________________ County, Idaho, to wit: ________________________________________________________________________ [Legal Property Description]. 2. Said lien is claimed to secure an indebtedness of $________________________ [Amount Claimed] with interest, after deducting all credits and offsets, from the _____ day of __________________, 20______, for ___________________________________. 3. The name of the owner or proprietor of the said property is _______________________________________________________________________. 4. If applicable, the undersigned was employed by or furnished materials to _______________________________________________________________________. This the _____ day of ____________________, 20_____. _____________________________ Signature ______________________________ Title______________________________ Corporation Attest: Secretary Before me, _______________, a Notary Public in and for the County of _______________, State of _______________, personally appeared _______________, who being duly sworn, doth depose and say that he or she is the __________________ of _____________________, that he or she signed the foregoing document as ___________________ of the corporation, that he or she has personal knowledge of the facts set forth in the foregoing statement of lien, and that the same are true and correct to the best of his her knowledge and belief. __________________________________________ Affiant State of Idaho County of ________________ Subscribed and sworn to (or affirmed) before me on this the _______________ day of _______________, 20____, by said Affiant. _________________________________________ Notary Public My Commission Expires on: ___________________________ (SEAL) Certificate of Delivery I, _____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing to ___________________________________ by: ( ) Personal Service ( ) Mailing a true and correct copy of same by certified U.S. mail, postage prepaid, return receipt requested to _____________________________________. So certified this the ______ day of ___________________, 20____. ________________________ Signature ID § 45-507