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Fill and Sign the Notice of Fliing Clalim of Lienindividual Form

Fill and Sign the Notice of Fliing Clalim of Lienindividual Form

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Notice of Filing Claim of Lien Page 1 of 2Prepared by, recording requested by and return to:Name: ____________________Company: _____________________Address: _____________________City: ________________State: _____Zip: __________Phone: ________________Fax: _________________----------------------Above this Line for Official Use Only---------------------Name of Claimant: ________________________________Name of Debtor: ________________________________Amount of Lien: _________________Tax Assessor’s Account Number: _________________Situs Address of Real Property: ________________________________________________________________________ NOTICE OF FILIING CLAIM OF LIEN – CORPORATION (Or. Rev. Stat. §87.039) COMES NOW, ___________________________________, as a representative of ________________________________ a _________________________________ corporation which has provided labor and/or materials for the improvement of the property located at and described as _______________________________________________________________________ (legal description that includes a metes and bounds description; a lot, block, subdivision; the book and page and/or instrument number of a recorded deed where the legal can be found; or a parcel in a partition), and would provide notice of the following: 1.A Statement of Claim of Lien regarding the above-described property was filed with the recording officer of ________________________________ County on the _____ day of _______________, 20_______.2. A copy of said lien claim is attached as a copy hereto. This the _____ day of ______________, 20_______ . ______________________________Signature ______________________________ Type or Print Name______________________________ Notice of Filing Claim of Lien Page 2 of 2 Title______________________________Corporation Attest: Secretary Certificate of Delivery I, _____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing to ___________________________________ by: ( )Personal Delivery ( )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

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