Fill and Sign the Montana Code Annotated Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: _____________________ Company: _____________________ Address: ______________________ City: ___________________ State: _____ Zip: __________ Phone: _______________ Fax: _________________ CONSTRUCTION LIEN NOTICE —INDIVIDUAL (M.C.A. § 71-3-535) COMES NOW, ________________________________ , as a party who has furnished services or materials and would state as follows: 1. This Lien is filed within ninety (90) days of the final furnishing of services or materials by the undersigned, or within ninety (90) days of the filing of a Notice of Completion by the property owner. 2. Each and every property owner of record has been served a copy of this Lien Notice, so certified by the undersigned in the attached Certificate of Service on Owner. 3. I, _______________________________________________________________ (insert name and address of person claiming the construction lien), claim a construction lien pursuant to Title 71, chapter 3, of the Montana Code Annotated. 4. I claim this lien against: ________________________________________________________________________ ________________________________________________________________________ ____________________________________ . [Give description of the real property against which the lien is claimed sufficient to identify it.] 5. The contracting owner is _________________________________ (insert name of the person who owns the real estate and name of the person who entered into the contract to improve it). 6. At the request of _______________________________________________________________________ (give name and address of party with whom person claiming the lien contracted to furnish services or materials), I provided the following: Construction Lien Notice Page 1 of 3 ________________________________________________________________________ ________________________________________________________________________ (give description of the services or materials provided). 7. The estimated amount remaining unpaid is $ _______________ (insert the amount unpaid; if no amount was fixed by the contract, give your good faith estimate of the amount and identify it as an estimate). 8. I first furnished these services or materials on the _____ day of ______________ , 20 ______ (give date), and last furnished services or materials on the _____ day of ______________ , 20 ______ (give date; if the date has not yet arrived, insert an estimate of the date on which services or materials will be last furnished and identify the date as an estimate). 9. I gave notice of the right to claim a lien as required by § 71-3-531 on the _____ day of ____________ , 20 ______ (give date), to _________________________________ (give name of contracting owner). (If it is not required to give a notice of the right to claim a lien, state the reason it is not required.) _______________________________________________________________________ . This the _____ day of _____________ , 20 ______ . ______________________________ Signature _____ _________________________ Type or Print Name STATE OF MONTANA COUNTY OF _______________ The instrument was acknowledged before me on _____________ (date), by __________________________________ (name(s)). ______________________________ Notary Public (SEAL) Title (and Rank): _______________ Printed Name: _________________ Residing at:____________________ My Commission Expires: ________________ MT § 71-3-536 Construction Lien Notice Page 2 of 3 CERTIFICATE OF SERVICE ON OWNER-INDIVIDUAL (M.C.A. § 71-3-534) I, __________________________________ , hereby certify that I have delivered this day a true and correct copy of the attached Lien Notice to each and every owner of record of the property named in said Lien Notice, namely __________________________________ , by: ( ) Personal Service ( ) Mailing a true and correct copy of same by certified U.S. mail, postage prepaid, return receipt requested to ________________________________ at his/her last known address. So certified this the _____ day of _____________ , 20 ______ . ______________________________ Signature _____ _________________________ Type or Print Name State of Montana County of ______________ ________________ (date) Signed and sworn to (or affirmed) before me on _____________ by __________________________________ (name(s) of person(s) making statement). ______________________________ Notary Public (SEAL) Title (and Rank): _______________ Printed Name: _________________ Residing at:____________________ My Commission Expires: ______________ MT § 71-3-534(2) Construction Lien Notice Page 3 of 3