Fill and Sign the Notice Right Lien Form

NOTICE OF RIGHT TO ASSERT A LIEN- INDIVIDUAL (NRS § 52-135(1)) STATE OF NEBRASKA COUNTY OF ___________________ THE UNDERSIGNED, who has entered into a contract under which he or she may claim a lien under the Nebraska Construction Lien Act hereby gives notice of the right to assert a lien to __________________________________ , the contracting owner, and in accordance with NRS § 52-135, states the following: 1. This is a notice of a right to assert a lien against real estate for services or materials furnished in connection with improvement of the real estate. 2. The owner or others may send communications to __________________________________ , claimant at the following address : __________________________________________________________________ _________________________________________________________________ . 3. The claimant contracted with ________________________________ whose address is: __________________________________________________________________ _________________________________________________________________ . 4. The lien is claimed against or may be claimed against _____________________________ , the owner. 5. The following is a general description of the services or materials provided or to be provided: __________________________________________________________________ _________________________________________________________________ . 6. The real estate against which the lien is or may be claimed is sufficiently described and identified as : __________________________________________________________________ _________________________________________________________________ . 7. The undersigned claimant is entitled to record a lien. Notice of Right to Assert a Lien Page 1 of 2 8. The following amount is the amount unpaid to the claimant for services or materials, whether or not due, or if no amount is fixed by the contract, the following is a good faith estimate of the amount designated as an estimate: __________________________________________________________________ _________________________________________________________________ . Warning. If you did not contract with the person giving this notice, any future payments you make in connection with this project may subject you to double liability. This the _____ day of _____________ , 20 ______ . __________________________________ Signature of Lien Holder _____ _____________________________ Type or Print Name State of Nebraska County of __________________ The foregoing instrument was acknowledged before me this __________________ (date) by ______________________________ (name of person). Signature       Title or Rank Serial Number, if any:             Type or Print Name Prepared by and Return to: (name and address)                         Notice of Right to Assert a Lien Page 2 of 2