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Fill and Sign the Understanding Mechanics Liens Minnesota Attorney General Form

Fill and Sign the Understanding Mechanics Liens Minnesota Attorney General Form

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VERIFIED STATEMENT OF ACCOUNT--INDIVIDUAL (M.S.A. § 514.07) COMES NOW, _________________________________, as a party entitled to a lien for labor, skill, or materials furnished for the improvement of the property at ________________________________________________________________, and would state as follows:1. On or about the _____ day of ______________ , 20______, the undersigned lien claimant received a request from the property owner for an itemized and verified account of the undersigned’s lien as well as the amount of the lien and the lien claimant’s name and address.2. Pursuant to that request, the lien claimant would respond as follows:(A)Date Material/Labor Provided Cost________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ (B) The estimated total amount of the lien claim is $___________. (C) My full name and address is ________________________________________________________________________ _______________________________________________________________________.3.Further, pursuant to Minnesota statute, the lien holder would hereby give notice that should the lien amount remain unpaid, the lien holder may commence a legal action to enforce his/her lien within ten (10) days of the furnishing of this notice. This the _____ day of ______________ , 20______. ______________________________Signature ______________________________ Type or Print Name STATE OF MINNESOTA COUNTY OF _______________ Signed and sworn to (or affirmed) before me on the _____ day of __________________________________, 20______, by ___________________________________ (name(s) of person(s) making statement). __________________________Signature (Notary Public) (Seal, if any) __________________________ __________________________ Title (and Rank) My commission expires: _________________ MN § 514.07

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