Fill and Sign the Notice of Filing Lien Statement Individual Form

Notice of Filing Lien Statement Page 1 of 1 NOTICE OF FILING LIEN STATEMENT-INDIVIDUAL (Okla. Stat. Ann. § 42-143.1) STATE OF OKLAHOMA ) ) ss COUNTY OF ___________________)TO:(Name) _________________________________ (Address) _______________________________________________________________________ YOU ARE HEREBY NOTIFIED that _________________________________ , as claimant whose address is ________________________________________, filed on the _____ day of ________________, 20______, a statement under oath claiming a mechanic’s lien, the same being No. ______________ against __________________________________ whose address is ________________________________________, and the following legally described property and the improvements thereon located, owned by you, for labor and materials performed and furnished by the claimant: _______________________________________________________________________.YOU ARE FURTHER NOTIFIED that under the lien statement, the claimant claims a lien on the premises in the sum of $______________ , the amount due under the contract with _________________________________ for labor and materials performed and furnished upon the improvements erected on the premises. This the _____ day of ______________, 20______. __________________________________Signature __________________________________Type or Print NameThe undersigned hereby certifies that the original copy of the Notice of Filing Lien Statement was mailed to __________________________________, at the address above shown, by Certified Mail No. _________________, return receipt requested, with postage prepaid thereon, this _____ day of _____________, 20_______.______________________________County Clerk______________________________Deputy