Fill and Sign the Name and Address of Lien Claimant Form

Notice of Lis Pendens – Individual Page 1 of 4 Prepared by: Return to: State of Mississippi County of ____________ ____________ Judicial District NOTICE OF LIS PENDENS - INDIVIDUAL(M.S.A. § 85-7-197) Name and Address of Owner: Name and Address of Lien Claimant: COMES NOW, ___________________________________, as a laborer, materialman or architect entitled, or who may become entitled, to a lien under M.S.A. § 85-7-131, et seq., or to give hereunder a stop notice to any owner, and provides notice of the following: 1. A civil action has been commenced in ________________ Court involving the parties as follows: _______________________________________ (Plaintiff) and ___________________________________ (Defendant). 2. The nature and object of this action is as follows: ______________________________________________________________________. 3. The real property affected by this action is located in ________________ County, Mississippi, and is legally described as follows: (See Exhibit A attached hereto and incorporated herein as though set forth in full) Notice of Lis Pendens – Individual Page 2 of 4 Indexing Instructions: 4. This Notice shall, from the time of the recording be notice both of the lien and of the pendency of the action to the owner and all other persons interested, all of whom shall thereupon be bound thereby. 5. The aggregate amount of the claims herein provided for shall not be a lien upon or bind the property for a greater amount than the original contract price or the amount of the owner's liability thereunder at the time this notice is filed, and in the event the lien shall exceed the sum of the contract price or the balance due thereunder, then they shall be paid pro rata. 6. Further, this notice shall not operate to extend the time during which the party entitled may bring an action on the claim or to enforce the right with reference to which his or her claim is filed, and when such rights cease, this notice shall be without effect. This the _____ day of __________________, 20_____. _________________________ Signature _________________________ Print or Type Name STATE OF MISSISSIPPI COUNTY OF _________________ Personally appeared before me, the undersigned authority in and for said county and state, on this ______ day of __________________ , 20______ , within my jurisdiction, the within named ______________________________ , who acknowledged that he/she/they executed the above and foregoing instrument. Notary Public My commission expires: Type or Print Name Notice of Lis Pendens – Individual Page 3 of 4 AFFIDAVIT OF SERVICE I, ___________________________________, hereby state that I have delivered a true and attested copy of the Notice of Lis Pendens to ________________________________, owner of the real property described as: _______________________________________________________________________________________________________________________________________________, on the _____ day of ______________, 20______ by: Mailing a true and attested copy of same by certified U.S. mail, postage prepaid, return receipt requested at his/her place of residence. Personal service at his/her usual place of abode. ________________________ Signature Notice of Lis Pendens – Individual Page 4 of 4 EXHIBIT A