Fill and Sign the Statement of Lien by One Other Than Original Form

Statement of Lien by One Other Than Original Contractor 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--------------------- STATEMENT OF LIEN BY ONE OTHER THAN ORIGINAL CONTRACTOR – INDIVIDUAL (Okla. Stat. Ann. §42-143) COMES NOW, __________________________________, as a subcontractor, artisan, or day laborer in the employ of a contractor providing labor and/or materials for the improvement of the property located at and described as ________________________________________________________________________ _______________________________________________________________________, and would state as follows.1. The undersigned began providing labor and/or materials for the improvement of the above-described property on or about the _____ day of _______________, 20______, and last furnished labor and/or materials on or about the _____ day of ________________, 20______.2. Said property is owned by ___________________________________, and may be provided a copy of this statement at the following address _______________________________________________________________________.3. The contractor primarily responsible for the improvement of said property is _________________________________, and may be provided with a copy of this statement at the following address _______________________________________________________________________.4. The undersigned provided the following labor and/or materials:Labor/Materials DateCost/Value________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Statement of Lien by One Other Than Original Contractor Page 2 of 2________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________ _______________________________________________________________________.5.The undersigned is currently owed the amount of $ ____________ from the above named contractor and hereby claims a lien against the above described property for that amount.This the _____ day of ______________, 20______. ______________________________Signature ______________________________ Type or Print Name Verification by Affidavit: State of OklahomaCounty of ______________________________________________________, of lawful age, being first duly sworn, upon oath, says: The he/she is the claimant mentioned in the foregoing statement of mechanic’s lien; that he/she had read said statement and knows the contents thereof; that the name of the owner, the name of the contractor, the name of the claimant, the description of the property upon which the lien is claimed, and the items of the account as therein set forth, are just, true and correct.Subscribed and sworn to before me this ______ day of __________________, 20______. Notary Public My Commission expires: My Commission Number: