Fill and Sign the Texas Affidavit Lien Form

Prepared by, recording requested by and return to:       ----------------------Above this Line for Official Use Only---------------------Name:       Company:       Address:       City:       State:       Zip:       Phone:       Fax:       NOTICE OF CONFIDENTIALITY RIGHTS: IF YOU ARE A NATURAL PERSON, YOU MAY REMOVE OR STRIKE ANY OF THE FOLLOWING INFORMATION FROM THIS INSTRUMENT BEFORE IT IS FILED FOR RECORD IN THE PUBLIC RECORDS: YOUR SOCIAL SECURITY NUMBER OR YOUR DRIVER’S LICENSE NUMBER. AFFIDAVIT OF LIEN-ORIGINAL CONTRACTOR-CORPORATION NOTICE: THIS IS NOT A LIEN. THIS IS ONLY AN AFFIDAVIT CLAIMING A LIEN. County of __________________ ) ) State of Texas ) A. Claimant:       Mailing Address:       (street, city, state, and zip code) Physical Address:       (street, city, state, and zip code) claims a mechanics' or materialman’s lien on the real property and improvement in the City of _________________ , County of _____________ , Texas, located at       . Affidavit of Lien Page 1 of 4 B. The legal description of the property is: [Insert legal description or attach as Exhibit A]                         . C. The following person(s) has an ownership interest in the property or are reputed to have a property interest in said Property:             (Name) (Last Known Address)             (Name) (Last Known Address)             (Name) (Last Known Address) D. Said claim is for the sum of $ ______________ , plus interest at the contract rate or the legal rate, whichever is higher from _____________ , which is due and unpaid to claimant (after deducting any just credits and offsets, if any) for labor, services, equipment and/or materials furnished by claimant and consisting of:                         . See attached contracts, invoices or other supporting documents incorporated as: Exhibit Description                                     E. Claimant was employed to furnish the same by       , Affidavit of Lien Page 2 of 4 whose address is       and furnished the same to       , whose address is       Dated and sworn to this _____ day of _____________ , 20 ____ at ________________ , ___________ . Signature and Acknowledgment of Corporation By:             Print Name Its:       Title Attest:       Corporate Secretary       Print Name STATE OF TEXAS COUNTY OF _____________ This instrument was acknowledged before me on _____(date)_____ by _________(name of officer)__________ , _____(title of officer)_____ of ____(name of corporation acknowledging)____ a _____(state of incorporation)_____ corporation, on behalf of said corporation. Notary Public       Printed Name My Commission Expires:       Affidavit of Lien Page 3 of 4 Certificate of Delivery I, ________________________________ , hereby certify that I have delivered this day a true and correct copy of the foregoing to ______________________________ by: Hand Delivery Mailing a true and correct copy of same by Certified or Registered U.S. Mail, postage prepaid, to _______________________________ , at his usual place of business located at _______________________________________________ . So certified this the _____ day of ________________ , 20 ____ . Signature TX Code § 53.052 Affidavit of Lien Page 4 of 4