Fill and Sign the Verified Statement of Lien by Corporation or Llc Alabama Form

Prepared by:       After Recording, Return to:       (Full Name of Party)       (Company, if applicable)       (Street Address)       (City, State and Zip Code) VERIFIED STATEMENT OF LIEN By CORPORATION, LLC, ETC. (Ala. Code § 35-11-213) State of Alabama ) ) ss. County of       )       , a       (Name of Business) (State Where Formed or Organized)       files this statement in writing, verified by the oath (Corporation, LLC, Partnership, etc.) of       , who has personal knowledge of the facts herein set (Name of Party Executing Claim) forth: 1. That said       claims a lien upon the (Name of Business) following property, situated in       County, Alabama, to wit: See Legal Description Attached as Exhibit A incorporated by reference as though set forth in full Legal Description:       This lien is claim, separately and severally, as to both the buildings and improvements thereon, and the said land. Verified Statement of Lien – Corporation, etc. Page 1 of 3 2. That said lien is claim to secure an indebtedness of $       , with interest, from the       day of       , 20       , for: (itemize and/or attach invoices) See Invoices/Statements Attached as Exhibit B incorporated by reference as though set forth in full Itemize:       The name of the owner or proprietor of the said property is:       (Name of Owner or Proprietor)       (Street Address)       (City, County, State, Zip Code) Date:             (Name of Business Entity) (Signature)       (Print or Type Name)       (Office, Position, Rank)       (Street Address)       (City, State, Zip Code) State of Alabama ,       County I,       , a       , in and (Name of Officer, Notary, etc.) (Position, Office or Rank of Officer) for said county in said state, hereby certify that       , who (Name of Party Executing Document) being duly sworn, doth depose and say: That he has personal knowledge of the facts set forth in the foregoing statement of lien, and that the same are true and correct to the best of his knowledge and belief. Verified Statement of Lien – Corporation, etc. Page 2 of 3 (Signature of Affiant)       (Type or Print Name) Subscribed and sworn to before me on this the       day of       , 20       , by said affiant. ( Signature of Officer) My Commission expires:             ( Type or Print Name) Verified Statement of Lien – Corporation, etc. Page 3 of 3 EXHIBIT A Street Address of Property:       Legal Description:       Verified Statement of Lien – Corporation, etc. Exhibit A EXHIBIT B Street Address of Property:       Itemized Statement and Attached Invoices:       Verified Statement of Lien – Corporation, etc. Exhibit B