Legal Claim of Lien Form

LEGAL CLAIM OF LIEN

This Claim of Lien is executed by Claimant Name: whose principal mailing address is Address of Claimant: against Property Owner Name: for work performed or materials supplied with respect to the estate or interest in real property described below, on the date set forth below.

RECITALS

WHEREAS, Claimant supplied labor, services, equipment and/or materials for the improvement of the real property described below pursuant to a contract or agreement with Contractor/Agent Name: ; and

WHEREAS, the total value of the labor, services, equipment and/or materials furnished by Claimant, together with interest, retainage, and lawful charges, remains unpaid in the aggregate amount set forth in this claim; and

WHEREAS, Claimant asserts and preserves all rights afforded by statute and common law to secure payment by recording a claim of lien against the property improved by the work or to which materials were supplied.

NOW, THEREFORE

Claimant hereby asserts a lien against the following described real property and states under penalty of perjury the facts set forth herein are true and correct.

1. PROPERTY DESCRIPTION

Street Address of Affected Property:

2. CONTRACT AND WORK

Original contract or agreement date: day of , .

Work Commencement Date: ; Work Completion Date (if completed): .

3. AMOUNT CLAIMED

Original contract amount (if applicable): $ .

Total amount now due and claimed as a lien: $ (principal), plus lawful interest, costs of collection, and recording fees.

4. NOTICE AND FILING

Claimant has complied with all preliminary notice requirements, demand notices, and statutory conditions precedent required to assert and maintain this lien, and this claim is being filed within the time prescribed by law to preserve lien rights.

Claimant requests that this Claim of Lien be recorded in the official records of the county or jurisdiction where the property is located and that the recorded claim be indexed against the above-described property.

5. REPRESENTATIONS AND WARRANTIES

Claimant represents and warrants that Claimant is entitled to enforce and record this lien; that the sums claimed are justly due and owing to Claimant for the labor, services, equipment and/or materials actually furnished to the property; and that no part of such sums has been paid, except as stated herein.

6. REMEDIES; ENFORCEMENT

Claimant reserves all remedies available at law or in equity, including the commencement of a foreclosure action to enforce this lien, collection of the amounts claimed, recovery of costs and attorneys' fees as permitted by contract or statute, and any ancillary relief appropriate to preserve or enforce Claimant's security interest in the property.

7. NOTICES

8. MISCELLANEOUS PROVISIONS

Governing Law: The validity, construction and enforcement of this Claim of Lien shall be governed by the laws of the State of , without regard to choice-of-law principles.

Entire Agreement: This Claim of Lien constitutes the entire statement of the lien asserted by Claimant and supersedes any prior oral or written statements with respect to the lien asserted herein.

Severability: If any provision of this Claim of Lien is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

Amendments and Waiver: No amendment, modification or waiver of any provision of this Claim of Lien shall be effective unless made in writing and signed by Claimant. No waiver by any party of any breach shall constitute a waiver of any other breach.

9. VERIFICATION

I declare under penalty of perjury under the laws of the State of that I am the Claimant (or an officer of the Claimant), that I have read the foregoing Claim of Lien and that the facts stated therein are true and correct to the best of my knowledge.

Executed on this day of , .

ADDITIONAL INFORMATION

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