Property Liens Form

PROPERTY LIENS FORM

Lienholder Name:     Property Owner Name:

WHEREAS RECITALS

WHEREAS, Lienholder provided labor, materials, equipment, services or other consideration in connection with improvements, repairs or other work performed upon or for the real property identified below; and

WHEREAS, a sum remains due and owing to Lienholder for the labor, materials or other consideration furnished, and Lienholder asserts a statutory and equitable lien on the described property to secure payment; and

WHEREAS, the parties intend to document the claim of lien, the amount claimed, the basis for the lien, and the procedures for recording, enforcement and release as set forth in this Property Liens Form.

SCOPE OF WORK

PROPERTY DESCRIPTION

CLAIM OF LIEN

Date debt became due:     Last date labor/material supplied:

Mechanic's / Construction Lien    Materials Supplied    Services Provided

Judgment Lien    Tax Lien    HOA / Assessment Lien

PAYMENT TERMS

RECORDING & NOTICE

Intended county recorder office:     Anticipated recording instrument number:

Date notice of claim sent to owner:     Method of notice: Certified mail Personal service Email

TERM AND TERMINATION

Effective start date:     Term expires or shall be re-evaluated on:

CONFIDENTIALITY

The parties acknowledge that certain financial, commercial and proprietary information exchanged in connection with the lien, the underlying transaction, and the documents referenced herein may be confidential. Each party agrees not to disclose such confidential information to third parties except (a) as required by law or court order, (b) to its legal or financial advisors on a need to know basis, or (c) with the prior written consent of the other party. This confidentiality obligation survives termination or release of the lien for a period of three years.

Lienholder and Property Owner acknowledge and agree to the confidentiality terms above.

GOVERNING LAW

This Property Liens Form, and any disputes arising out of or relating to it, shall be governed by and construed in accordance with the laws of the state of , without regard to conflicts of law principles.

ENTIRE AGREEMENT

This document, together with any attached exhibits and supporting documents listed above, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior negotiations, understandings and agreements, whether written or oral. No amendment or modification shall be effective unless in writing and signed by both parties.

REMEDIES; ENFORCEMENT; RELEASE

Upon default in payment of the amounts secured by the lien, Lienholder may enforce the lien by all remedies available under applicable law, including foreclosure, sale or other judicial or non-judicial remedies. Lienholder is entitled to recover reasonable attorneys' fees, costs of collection, recording fees and other expenses incurred in enforcing this lien to the extent permitted by law. Upon receipt of full payment in accordance with the payment terms, Lienholder shall execute and record a full release or satisfaction of lien within a commercially reasonable time.

CERTIFICATION

Lienholder certifies under penalty of perjury that the information set forth in this form is true and correct to the best of Lienholder's knowledge, that the amounts claimed are justly due and owing, and that Lienholder intends to record this claim of lien or cause it to be recorded in the appropriate public records unless the lien is paid or otherwise resolved.

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