Fill and Sign the Notice of Unpaid Balance and Right to File Lien Mechanic Liens Individual New Jersey Form

Prepared by:       After Recording, Return to:                         TO THE CLERK, COUNTY OF       : NOTICE OF UNPAID BALANCE AND RIGHT TO FILE LIEN (Individual Claimant) In accordance with the "Construction Lien Law," P.L. 1993, c. 318(C. 2A:44A-1 et al.), notice is hereby given that: 1.       , individually, located at (Name of claimant)       (Business address of claimant) has on       , a potential construction lien against the real property of (date)       , (name of owner of property subject to lien) in that certain tract or parcel of land and premises described as Block       , Lot       , on the tax map of the Borough of       , County of       , State of New Jersey, in the amount of       Dollars ($       ), as calculated below for the value of the work, services, material or equipment provided. If the claim is against a community association in accordance with section 3 of P.L. 1993, c. 318 (C. 2A:44A-3) set forth the name of the community association and the name and location of the property development: Name of Community Association:       Location of Property Development:       Name of Property Development:       Notice of Unpaid Balance and Right to File Lien Page 1 of 4 The lien is to be claimed against the interest of the owner, unit owner, or against the community association in accordance with section 3 of P.L. 1993, 318 (C. 2A:44A-3) or other party if "other", describe:       2. The work, services, material or equipment was provided pursuant to the terms of a written contract, or in the case of a supplier, a delivery or order slip signed by the owner, community association, contractor, or subcontractor having a direct contractual relation with a contractor, or an authorized agent of any of them, dated       , between the claimant       and owner, unit owner, community association, contractor or subcontractor, named or known as       and located at (name of contracting party)       , (address of other contracting party) in the total contract amount of       Dollars ($       ) together with (if applicable) amendments to the total contract amount aggregating       Dollars ($       ). 3. In accordance with the above contract, this claimant performed the following work or provided the following services, material or equipment: a.       b.       c.       d.       (If more space is required, attach additional sheets.) 4. The date of the provision of the last work, services, material or equipment for which payment is claimed is       . (date) 5. The amount due for work, services, material or equipment delivery provided by claimant in connection with the improvement of the real property, and upon which this lien claim is based, is calculated as follows: Notice of Unpaid Balance and Right to File Lien Page 2 of 4 A. Initial Contract Price: $       B. Executed Amendments to Contract Price/Change Orders: $       C. Total Contract Price (A + B) = $       D. If Contract Not Completed, Value Determined in Accordance with the Contract of Work Completed or Services, Material, Equipment Provided: $       E. Total from C or D (whichever is applicable): $       F. Agreed upon Credits: $       G. Amount Paid to Date: $       TOTAL LIEN CLAIM AMOUNT (E minus [F+G]) = $       6. The written contract is is not (select one) a residential construction contract as defined in section 2 of P.L. 1993, c. 318 (C. 2A:44A-2). 7. This notification has been lodged for record prior or subsequent to completion of the work, services, material or equipment as described above. The purpose of this notification is to advise the owner or community association and any other person who is attempting to encumber or take transfer of said property described above that a potential construction lien may be lodged for record within the 90-day period, or in the case of a residential construction contract within the 120-day period, following the date of the provision of the last work, services, material or equipment as set forth in paragraph 4 of this notice. CLAIMANT'S REPRESENTATION AND VERIFICATION Claimant represents and verifies that: 1. I have authority to file this Notice of Unpaid Balance and Right to File Lien. 2. The claimant is entitled to the amount claimed herein at the date this Notice is lodged for record, pursuant to claimant's contract described in the Notice of Unpaid Balance and Right to File Lien. Notice of Unpaid Balance and Right to File Lien Page 3 of 4 3. The work, services, material or equipment for which this Notice of Unpaid Balance and Right to File Lien is filed was provided exclusively in connection with the improvement of the real property which is the subject of this Notice of Unpaid Balance and Right to File Lien. 4. The Notice of Unpaid Balance and Right to File Lien has been lodged for record within 90 days, or in the case of a residential construction contract within 60 days, from the last date upon which the work, services, material or equipment for which payment is claimed was provided. 5. The foregoing statements made by me are true, to the best of my knowledge. Signature of Claimant       Print or Type Name       Title (if any) STATE OF NEW JERSEY COUNTY OF       ss: On this       day of       , 20       , before me, the subscriber, personally appeared       who, I am satisfied, is the person named in and who executed the within instrument, and thereupon acknowledged that claimant signed, sealed and delivered the same as claimant's act and deed, for the purposes therein expressed. Signature of Notary Public NOTARY SEAL Notice of Unpaid Balance and Right to File Lien Page 4 of 4