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Fill and Sign the Nj Lien 497319180 Form

Fill and Sign the Nj Lien 497319180 Form

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LIST OF PERSONS WITH RIGHT TO CLAIM A LIEN--CORPORATION I, __________________________________ , Contractor/Subcontractor received on the _____ day of _______________ , 20 ______ , a request from _________________________________ Owner/Contractor to provide an accurate and full list of the names and addresses of each subcontractor and supplier who may have a right to file a lien. Name Address Other _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ Name Address Other _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ Name Address Other _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ Name Address Other _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ See attached for additional Names. This the _____ day of ________________ , 20 ______ . ______________________________ Corporation ______________________________ By _____ _________________________ Type or Print Name _____ _________________________ Title List of Persons with Right to Claim a Lien Page 1 of 4 AFFIDAVIT STATE OF NEW JERSEY COUNTY OF _______________ Before me, ___________________________________ , a Notary Public in and for the County of ________________ , State of _______________________ , personally appeared ___________________________________ , who being duly sworn, doth depose and say: That he has personal knowledge of the facts set forth in the foregoing List of Persons with Right to Claim Lien, and that the same are true and correct to the best of his knowledge and belief. ______________________________ Affiant Subscribed and sworn to before me on this the _____ day of _____________ , 20 ______ , by said affiant. ______________________________ Notary Public ______________________________ Type or Print Name My Commission Expires: __________________________________ List of Persons with Right to Claim a Lien Page 2 of 4 Name Address Other List of Persons with Right to Claim a Lien Page 3 of 4 Name Address Other Name Address Other Name Address Other Name Address Other Name Address Other Name Address Other Name Address Other NJ § 2A: 44A-37 List of Persons with Right to Claim a Lien Page 4 of 4

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