Fill and Sign the Tennessee Notice of Lien Corporation or Llc Form

Notice of Lien Page 1 of 3Prepared by, recording requested by and return to:Name: _____________________Company: ___________________Address: ___________________City: ___________________State: _____Zip: __________Phone: ________________Fax: ________________Reference Instrument Number: ________________----------------------Above this Line for Official Use Only--------------------- Notice of Lien -- Corporation (Tenn. Code Ann. § 66-11-112) This instrument was prepared by: Name: ___________________________________ Address: _______________________________________________________________STATE OF TENNESSEECOUNTY OF ______________________________________________________, being first duly sworn, as a representative of _________________________________ a __________________________________ corporate lien claimant, says that the lien claimant furnished certain materials or performed certain work or labor in furtherance of improvements to the real property hereinafter described, in pursuance of a certain contract, with __________________________________, (the owner, prime contractor, remote contractor, or other person, as the case may be), and would provide notice of the following: 1.The first of the work or labor was performed or the first of the material, services, equipment, or machinery was furnished on the _____ day of _______________, 20_______. The last of the work or labor was performed or the last of the material, services, equipment, or machinery was furnished on the _____ day of _______________, 20_______.2. There is justly and truly due the lien claimant therefor from __________________________________, (the owner, prime contractor, remote contractor, or other person, as the case may be) over and above all legal setoffs, the sum of _______________ dollars, for which amount the lien claimant claims a lien under T.C.A. §§ 66-11-101, et seq. on the real property, of which __________________________________ is or was the owner, which is described as Notice of Lien Page 2 of 3follows: ________________________________________________________________________ _______________________________________________________________________________________________________________________________________________. This the _____ day of _________________, 20 _______. _________________________Signature of Lienor _________________________ Type or Print Name _________________________ Title_________________________Corporation Attest: Secretary Subscribed and sworn to before me on this the _____ day of _____________, 20________, by said affiant. ______________________________Notary Public My Commission Expires: ________________STATE OF TENNESSEECOUNTY OF _______________ Personally appeared before me, the undersigned, a Notary Public within and for said State and County aforesaid, duly commissioned and qualified, ___________________________________ of the state and county mentioned, personally appeared ___________________________________, with whom I am personally acquainted (or proved to me on the basis of satisfactory evidence), and who, upon oath, acknowledged such person to be president (or other officer authorized to execute the instrument) of ___________________________________, the within named bargainor, a corporation, and that such president or officer as such __________________________________, executed the foregoing instrument for the purpose therein contained, by signing the name of the corporation by himself/herself as such officer. Witness my hand and seal, at office in _____, this __________ day of ______. Notice of Lien Page 3 of 3Notary PublicMy commission expires: Type or Print Name