Fill and Sign the Mechanics Lien 481378905 Form

Construction Lien Questionnaire Form Client Information Legal name of company claiming the lien: Company formation: Sole Proprietorship Partnership Corporation State of incorporation: Current address: County where office located: Contact person and telephone number: Who will sign the lien (preferably an owner, partner or officer of the corporation)?:   Title: Name of prime contractor: Street: City: State: Zip: Contract Information Name of owner of the premises: Street: City: State: Zip: Current property owner(s) address if different: Original Contract Amount: $ Do you have a signed contract? Yes No If yes, who signed the contract? Payment date(s) in the contract: Extras: $ Amount(s) Paid to Date: $ If applicable: Mechanic’s lien date: Lis pendens date: Waivers: Please attach copies of any Agreements, Contracts, Invoices, Change Orders, Lien Waivers, Pre-Lien Notice and any other information that may be helpful. Consumer rights pamphlet provided: Yes No Consumer Rights Acknowledgement Form Executed: Consumer rights pamphlet provided: City agency involved: Work Performed Information Legal description of property where work was performed: County where property is located: Street address of the property: Dollar amount of claim (list interest or finance charges separately and do not include any amounts for work not yet performed): First date work performed (including delivery of equipment and materials): Last date work performed (not including warranty work): Name and employer of person that directed you to do the work: Address: Telephone: Name(s) of any bank(s) financing the construction, if known: Brief description of work/improvements you provided to the property: Was pre-lien notice given to the property owner before beginning work?: Yes No WHAT IS YOUR PREFERENCE FOR VERIFICATION OF INFORMATION?: VERIFY ONLY PROPERTY OWNERSHIP AND LEGAL DESCRIPTION; ALL OTHER INFORMATION SHALL BE RELIED UPON AS STATED ABOVE. VERIFY ONLY THE FOLLOWING INFORMATION: ALL OTHER INFORMATION SHALL BE RELIED UPON AS STATED ABOVE.