Fill and Sign the Mechanics Lien Individual Form

Mechanic’s Lien Page 1 of 2Prepared by, recording requested by and return to:Name: _____________________Company: _____________________Address:_______________________ City: ____________________State: _____Zip: _________Phone: _________________Fax: ___________________----------------------Above this Line for Official Use Only--------------------- MECHANIC’S LIEN -INDIVIDUAL (N.D.S. § 35-27-13) COMES NOW, _________________________________, as a party which has provided labor and/or materials for the improvement of the property located at and described as _______________________________________________________________________________________________________________________________________________, and would state as follows:1.The undersigned provided labor and/or materials for the improvement of the above-described property under and pursuant to a contract with or at the request of _________________________________.2.The name of the owner or reputed owner, if known, of the above-described property is ________________________________.3. The undersigned has kept an itemized account of such labor and/or materials, separate and apart from all other items of account against the purchaser, and after deducting all just credits and offsets, is owed the amount of $_____________, which the undersigned has not been paid in full.4.Due and written notice demanding payment of the undersigned’s account for such labor and/or materials has been made upon the owner as provided by law. 5.The undersigned is entitled to a mechanic’s lien and a mechanic’s lien for the undersigned’s account is hereby filed and claimed on the buildings and land described above.This the _____ day of ______________ , 20_______. ______________________________Signature Mechanic’s Lien Page 2 of 2______________________________ Type or Print Name STATE OF NORTH DAKOTACOUNTY OF __________________The foregoing instrument was acknowledged before me this _____ day of _______________, 20______ by ___________________________________ (name of person acknowledging). _____________________________Notary Public Printed Name: _________________ My Commission Expires: ________________