Protect the lien rights of all the subtrades and suppliers on a construction project with this Mechanics Lien Sworn Statement for Illinois contractors.
- The Sworn Statement is made by the general contractor, upon request of a property owner, to give notice of all parties that have provided labor, materials or services with respect to improvements to the property.
- The form includes copies of the relevant sections of the Illinois Mechanics Lien Act.
- Buy the form once, and it's yours to use as often as you require.
This Illinois Mechanic's Lien Sworn Statement is in MS Word format, and is easy to print, download and use.
MECHANICS LIEN SWORN STATEMENT STATE OF ILLINOIS COUNTY OF [COUNTY], SS: PROPERTY OWNER: Name: ______________________________________________________________________________________ Street Address: _______________________________________________________________________________ City, State, Zip: _______________________________________________________________________________ ORIGINAL CONTRACTOR: Name: ______________________________________________________________________________________ Street Address: _______________________________________________________________________________ City, State, Zip: _______________________________________________________________________________ Contact Person (if company): ___________________________________________________________________ OTHER INTEREST HOLDERS: [List names and addresses of any other parties that the lien claimant is aware of which have an interest in the property.] and the spouse of any individual herein named, and all unknown and unrecorded claimants. SUBJECT PROPERTY: -2- Address: ____________________________________________________________________________________ Legal Description: Attached hereto as Exhibit A. Permanent Real Estate Index Number(s): ________________________________________________________ Pursuant to and in compliance with the Mechanic's Lien Act, being Sections 5 and 22, this Mechanics Lien Sworn Statement is provided by the undersigned upon request of the above named Property Owner. Section 5 of the Illinois Mechanics Lien Act requires a contractor or subcontractor that has an agreement with the property owner to provide a statement in writing of the names and addresses of all parties, furnishing materials and labor and of the amounts due or to become due. Section 22 of the Illinois Mechanics Lien Act requires that a contractor or subcontractor that has an agreement with someone other than the property owner to provide a statement in writing of the persons furnishing material and labor, providing the names and addresses of all parties, furnishing materials and labor and of the amounts due or to become due. The undersigned has provided labor and/or materials to a construction project at the Subject Property. The Property Owner (or the agent of the Property Owner) has, pursuant to Illinois law, demanded of the undersigned a sworn statement compliant with said Section 5 or 22, and the undersigned wishes to provide same. Name of Subtrade / Address Amount Due or Notes Supplier to Become Due -3- -4- STATE OF ILLINOIS ) ) COUNTY OF [COUNTY], SS: ) The undersigned Affiant, first being duly sworn upon oath, deposes and says that he/she has the authority to sign on behalf of the Claimant named herein; that he/she has read the foregoing Mechanics Lien Sworn Statement including all attachments thereto, and knows the contents thereof, and that all of the statements contained therein are true. Date Signature Print Name & Title (if any) Name of Contractor/Subcontractor (If company) Subscribed and sworn to before me this _____ day of ______________, 20_______. Notary Public My Commission expires: MAIL TO / PREPARED BY: Name: _________________________________________________________ Address: _______________________________________________________ ________________________________________________________ -5- ACT 60 MECHANICS LIEN ACT 60/5 Statement Under Oath of Persons Furnishing Work and Materials, Notice, Notice to
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