Fill and Sign the Nm Corporation 497319922 Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ____________________ Company: ____________________ Address: _____________________ City: ___________________ State: _____ Zip: __________ Phone: _________________ Fax: ________________ CLAIM OF LIEN _- CORPORATION (N.M. Stat. Ann. § 48-2-6) COMES NOW, _______________________________ , as a representative of a _________________________________ a __________________________________ corporation which has provided labor and/or materials for the improvement of the property located at and described as ________________________________________________________________________ _______________________________________________________________________ , (if using the description contained in or shown by one or more maps, plats, descriptions, deeds, mortgages or other instruments of record in the office of the county clerk of the county in which the affected real estate is located, the description must include the time and place of filing or recordation of the instrument containing the description referred to, or other similar information, to locate and identify the instrument containing the description) and would state as follows: 1. The undersigned completed a contract with the property owner, or is not a contractor but ceased providing labor and/or materials, on the _____ day of ________________ , 20 ______ . 2. The undersigned is entitled to a lien, after deducting all just credits and offsets, in the amount of $ _____________ . 3. The name of the owner or reputed owner, if known, of the above-described property is ________________________________ . 4. The name of the person by whom the undersigned was employed, or to whom the undersigned furnished labor and/or materials is _________________________________ . 5. If the above mentioned labor and/or materials were provided under contract, the terms of that contract, time given, and the conditions of the contract are: ________________________________________________________________________ Claim of Lien Page 1 of 3 ________________________________________________________________________ _______________________________________________________________________ . This the _____ day of ________________ , 20 ______ . ______________________________ Signature _____ _________________________ Type or Print Name _____ _________________________ Title _____ _________________________ Corporation Attest: Secretary STATE OF NEW MEXICO COUNTY OF ________________ Signed and sworn (or affirmed) before me under oath this the _____ day of ________________ , 20 _______ , by __________________________________ , who acknowledges that the matters and things alleged in the foregoing Lien Claim are true and correct to the best of his knowledge as therein stated. ______________________________ Notary Public My Commission Expires: (SEAL) _____________________ STATE OF NEW MEXICO COUNTY OF _________________ The instrument was acknowledged before me on the _____ day of ______________ 20 ______ , by ___________________________________ (name(s) of person(s) as type of authority, e.g., officer, trustee, etc.), of ________________________ (name of corporation), a ____________________ (state or county of incorporation) corporation, on behalf of said corporation. ______________________________ Notary Public Claim of Lien Page 2 of 3 Printed Name: _________________ (SEAL) My Commission Expires: ___________________ Note: document should include corporate seal or statement that corporation has no seal. NM § 48-2-6 Claim of Lien Page 3 of 3