Fill and Sign the Notice of Lien Class 2 Structure Corporation or Llc Indiana Form

Notice of Lien- Class 2 Structure - Corporation (I.C.A. § 32-28-3-3(b)) COMES NOW _______________________________ as representative of __________________________________ a ___________________________________ corporation of (address) __________________________________________________ , and hereby provides notice of the following: 1. The undersigned corporation has performed labor or furnished material or machinery for improvements to a Class 2 structure (as defined in IC 22-12-1-5) or for an improvement on the same real estate auxiliary to a Class 2 structure located at (legal description and street address, if any) See Legal Description Attached as Exhibit A incorporated by reference as though set forth in full Legal Description:       2. The above-mentioned property is owned by ______________________________ of (address) ____________________________________________________________ . 3. The undersigned corporation is entitled to a lien for the value of labor performed or material furnished in the amount of $ ________________ . 4. Labor was performed or material provided on the _____ day of _______________ , 20 _____ , being within sixty days (60) of the filing of this notice. Notice of Lien – Class 2 Structure Page 1 of 3 Signature       Type or Print Name       Title       Corporation Attest: Secretary STATE OF INDIANA ,       County, ss: Before me, the undersigned, a Notary Public in and for said County and State, personally appeared the within named       , who acknowledged the execution of the foregoing NOTICE OF LIEN – CLASS 2 STRUCTURE for and on behalf of said ________________________ , a corporation , and who, being duly sworn, stated that the representations therein contained are true. Witness my hand and       Seal this       day of       , 20       . Notary public. Resident of       County. My Commission expires       , 20       This Instrument was prepared by: Notice of Lien – Class 2 Structure Page 2 of 3                         Signature       Print or Type Name Affirmation Statement I affirm, under the penalties for perjury, that I have taken reasonable care to redact each Social Security number in this document, unless required by law. Signature       Print or Type Name Notice of Lien – Class 2 Structure Page 3 of 3