Fill and Sign the Nebraska Mechanics Lien Law in Construction Faqs Forms

Claim of Lien Page 1 of 2 CLAIM OF LIEN- INDIVIDUAL (NRS § 52-147) STATE OF NEBRASKACOUNTY OF ___________________Before me, the undersigned notary public, personally appeared ________________________________, who was duly sworn and says that she or he is (the lienor herein) (the agent of the lienor herein __________________________________), whose address is _____________________________________________________________________ ; and that in accordance with a contract with _________________________________, whose address is ___________________________________________________________________, lienor furnished labor, services, or materials consisting of ______________________________________________________________________________ ______________________________________________________________________________ on the following described real property in __________________________________ County, Nebraska:______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (insert legal description)owned by ______________________________ of a total value of $ __________________, of which there remains unpaid $____________, and furnished the first of the items on __________________, 20______, and the last of the items on __________________, 20______; and (if the lien is claimed by one not in privity with the owner) that the lienor served her or his notice to owner on __________________ , 20______, by ________________________ (method of service); and (if required) that the lienor served copies of the notice on the contractor on __________________, 20______, by ________________________ (method of service); and on the subcontractor, ________________________, on __________________, 20______, by ________________________ (method of service). Signature of Lienor/Agent Printed Name of Lienor/Agent Address Claim of Lien Page 2 of 2State of NebraskaCounty of __________________The foregoing instrument was acknowledged before me this __________________ (date) by ______________________________ (name of person).Signature Title or RankSerial Number, if any: Type or Print NamePrepared by and Return to: (name and address)