Fill and Sign the Mechanic Lien Form

AFFIDAVIT FOR MECHANICS' LIEN - INDIVIDUAL State of Ohio, County of _________________ , ss: __________________________________ , whose address is ________________________ , being first duly sworn, says that _________________________________ , the lien claimant, furnished certain material or performed certain labor or work in the furtherance of improvements located on or removed to the land hereinafter described, in pursuance of a certain contract, with __________________________________ , the owner, part owner, lessee, original contractor, subcontractor, or other person, as the case may be, whose address is ________________________ . The first of the labor or work was performed or material was furnished on the _____ day of ________________ , 20 ______ . The last of the labor or work was performed or material was furnished on the _____ day of _______________ , 20 ______ and there is justly and truly due ________________________________ , the lien claimant, therefor from __________________________________ , the owner, part owner, lessee, original contractor, subcontractor, or other person, as the case may be, over and above all legal setoffs, the sum of ________________ dollars, for which amount ________________________ , the lien claimant, claims a lien on the land, building, or leasehold, of which ________________________ is or was the owner, part owner, or lessee, as the case may be, which property is described as follows:       Affidavit for Mechanic’s Lien – Individual Page 1 of 2 __________________________________________ Affiant _____ _____________________________________ Type or Print Name STATE OF OHIO COUNTY OF _____________________ Sworn to before me and subscribed in my presence this _____ day of ___________, 20 _____. _________________________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________ NOTE Section 1311.07 provides that: “Any person filing an affidavit pursuant to section 1311.06 of the Revised Code [Affidavit of Mechanic’s Lien] shall serve a copy of the affidavit on the owner, part owner, or lessee of the improved property or his designee, within thirty days after filing the affidavit. If the affidavit cannot be served in accordance with section 1311.19 of the Revised Code, then the person shall serve the copy by posting it in some conspicuous place on the premises of the improved property within ten days after the expiration of the thirty days.” This Instrument was prepared by:                         Signature       Print or Type Name Affidavit for Mechanic’s Lien – Individual Page 2 of 2