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Fill and Sign the Notice of Claim More Remote Than 3rd Tier Individual North Carolina Form

Fill and Sign the Notice of Claim More Remote Than 3rd Tier Individual North Carolina Form

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NOTICE OF CLAIM OF LIEN BY SUBCONTRACTOR MORE REMOTE THAN THE THIRD TIER - INDIVIDUAL (N.C. Gen. Stat. § 44A-19) To: 1. ______________________________________________________________________ _______________________________________________________________________ , person holding funds against which lien is claimed. (Name and address) General description of real property where labor performed or material furnished: ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ . General description of undersigned lien claimant's contract including the names of the parties thereto: ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ . The amount of lien claimed pursuant to the above described contract: $ ______________ . The undersigned lien claimant gives this notice of claim of lien pursuant to North Carolina law and claims all rights of subrogation to which he or she is entitled under Part 2 of Article 2 of Chapter 44A of the General Statutes of North Carolina. Dated ______________________ ________________________ Lien Claimant _____ ___________________ Type or Print Name _____ ___________________ ________________________ (Address) Notice of Claim of Lien Page 1 of 2 Certificate of Delivery I, _____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing to ___________________________________ by: ( ) Personal Service ( ) Mailing a true and correct copy of same by certified or registered U.S. mail, postage prepaid, return receipt requested. So certified this the ______ day of ___________________, 20____. ________________________ Signature Notice of Claim of Lien Page 2 of 2

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