Fill and Sign the Lien Public Sale Form

Notice of Lien of Jeweler for Repairs and Public Sale To: ________________________________________________ (Jeweler) Street Address or Post Office Box____________________________________________ City, state, and zip code ____________________________________________________ Notice is hereby given that ______________________________________ (Jeweler), the undersigned jeweler, whose principal place of business is at _____________________________ _____________________________________________________________ (street address, city, county, state, zip code) , claims a lien on your _________________________________ [describe jewelry , such as: “ watch or ring” and if statutory authority exists for the lien, add: “pursuant to _____________________________________________ (cite statute)”] . Said ______________________________ (e.g., watch or ring) is hereinafter called Property. In order to perfect such lien, the undersigned submits the following account of labor performed and materials supplied: 1. On _______________________________ (date) , the undersigned, pursuant to _______________________ (a written or an oral) agreement with you, expended labor and materials on said Property owned by you. 2. The labor performed consisted of __________________________________________ ___________________________________________________ (describe labor) , and materials and/or parts. The cost of labor, parts and/or materials and their prices are listed as follows: Item(s) Price _________________________________________ _____________ _________________________________________ _____________ _________________________________________ _____________ 3. The undersigned claims a lien on the above-described property in the amount of $_______________, which represents the agreed value for the labor performed and the materials furnished for which the undersigned has not received payment . 4. No part of the $_______________ set forth above has been paid by you, as owner, to the undersigned, which leaves an unpaid balance of $_________________ still due and owing to the undersigned. 5. You are further notified that you may redeem your Property by payment of the amount claimed within ____days after this notice has been mailed by certified or registered mail, with return receipt requested . If the property is not redeemed within this time, it will be sold to the highest bidder at ___________________________________________________ (place of sale) , on _________________________ (date) , at ____________ (time) , to satisfy the amount claimed by the undersigned. The costs incurred by the undersigned in giving this notice and selling the Property will be deducted from any money that remains after the satisfaction of the lien. The remainder of the money, if any, will be mailed to you at _______________________________ ________________________________________________________________ (street address, city, county, state, zip code) . Witness my signature this the ____, day of _________________________, 20___. ______________________________ (Name of Jeweler/Jewelry Store) Lienholder