Fill and Sign the Nevada Lien Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ________________ Company: ____________________ Address: ___________________ City: _________________ State: _____ Zip: __________ Phone: __________________ Fax: ___________________ NOTICE OF LIEN—CORPORATION (Nevada Revised Statute §108.226) (Assessor's Parcel Numbers: ____________________________________ ) Th e undersigned corporate representative cl aims a lien upon the property described in this notice for work, materials or equipment furnished or to be furnished for the improvement of the property: 1. The amount of the original contract is: $ ______________________ . 2. The total amount of all additional or changed work, materials and equipment, if any, is: $ ______________________ . 3. The total amount of all payments received to date is $ ______________________ . 4. The amount of the lien, after deducting all just credits and offsets, is $ ______________________ . 5. The name of the owner, if known, of the property is ___________________________ . 6. The name of the person by whom the lien claimant was employed or to whom the lien claimant furnished or agreed to furnish work, materials, or equipment is: __________________________________ . 7. A brief statement of the terms of payment of the lien claimant’s contract is: ________________________________________________________________________ _______________________________________________________________________ . 8. A description of the property to be charged with the lien is: ________________________________________________________________________ _______________________________________________________________________ . Notice of Lien Page 1 of 3 (If provided in metes and bounds, also include the name and mailing address of the person who prepared the legal description. If a document including the same legal description previously has been recorded, include all information necessary to identify and locate the previous recording, but not the name and mailing address of the person who prepared the legal description). According to NRS 108.227, each subcontractor who participated or will participate in the above-described construction, improvement, alteration or repair of the work of improvement has delivered a copy of this notice of lien to the prime contractor. DATED this _____ day of ______________ , 20 ______ . _____________________________ Signature _____ ________________________ Type or Print Name _____ ________________________ Title _____ ________________________ Name of Corporation Attest: Secretary State of Nevada ) ) ss. County of _______________ ) _________________________________ (print name), being first duly sworn on oath according to law, deposes and says: I have read the foregoing Notice of Lien, know the contents thereof and state that the same is true of my own personal knowledge, except those matters stated upon information and belief, and, as to those matters, I believe them to be true. ___________________________________________ (Authorized Signature of Lien Claimant) Subscribed and sworn to before me this ____ day of the month of ____________ of the year ______ . ______________________________ Notary Public in and for the County and State Notice of Lien Page 2 of 3 CERTIFICATE OF DELIVERY I,       , hereby certify that I have delivered this day a true and correct copy of the foregoing to       by: (select one of the four options) Personal Service to the Owner or the Owner’s Registered Agent Mailing a copy of the above document by certified mail, return receipt requested, to the owner at the owner’s place of residence or owner’s usual place of business Mailing a copy of the above document by certified mail, return receipt requested, to the registered agent of the owner at the address of the registered agent; OR Since the place of residence or business of the owner and the address of the registered agent cannot be determined: (1) Fixing a copy of the notice of lien in a conspicuous place on the property; (2) Delivering a copy of the notice of lien to a person there residing, if such a person can be found; and (3) Mailing a copy of the Notice of Lien addressed to the owner at: (check all applicable) (a) The place where the property is located; (b) The address of the owner as identified in the deed; (c) The address identified in the records of the office of the county assessor, or (d) The address identified in the records of the county recorder of the county in which the property is located. So certified this the ______ day of ___________________, 20____. Signature       Print/Type Name Notice of Lien Page 3 of 3