Illinois Mechanics Lien Sworn Statement by Megadox

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									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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