Fill and Sign the Maryland Notice Lien Form

Notice to Owner or Owner’s Agent of Intention to Claim a Lien Page 1 of 2 Notice to Owner or Owner’s Agent of Intention to Claim a Lien -- Individual (Md. Code Ann. §9 -104) 1. ___________________________________ (Name of Subcontractor or Company) did work or furnished material for or about the building generally designated or briefly described as: ________________________________________________________________________ _______________________________________________________________________ . 2. The total amount earned under the subcontractor's undertaking to the date hereof is $ __________________ of which $ __________________ is due and unpaid as of the date hereof. 3. The work done or materials provided under the subcontract were as follows: (insert brief description of the work done and mater ials furnished, the time when the work was done or the materials furnished, and the name of the person for whom the work was done or to whom the materials were furnished). W ork Done/Materials Furnished Date Name ________________________________________________________________________ _____ ___________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _____________________________________________ ___________________________ ________________________________________________________________________ I do solemnly declare and affirm under th e penalties of perjury that the contents of the foregoing notice are true to the best of the affiant's knowledge, information, and belief. _____________________________ Affiant _____ ________________________ Type or Print Name Sworn and s ubscribed to before me this ______ day of ________________ ______, 20 _____ __. ____________________________ Signature of Notary Public ____________________________ Type or Print Name Notice to Owner or Owner’s Agent of Intention to Claim a Lien Page 2 of 2 [Notary Seal] My commission expires: ________________ Certificate of Delivery I, _________ ____________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing to ___________________________________ by: ( ) Personal Service ( ) Registered or Certified Mail, return receipt requested ( ) Mail ing a true and correct copy of same by certified U.S. mail, postage prepaid, return receipt requested to ___________________________, who is the lien claimant located at ______________________________________. So certified this the ______ day of ________ ___________, 20____. ________________________ Signature