RECORDING REQUESTED BY:
WHEN RECORDED MAIL TO:
Space above for Recorder’s use only
COMES NOW, _____________________________ [insert name of person or firm who is claiming the lien], of
________________________ [address]. __________________ [city], Wyoming,, who hereby claims a
Mechanic’s Lien against __________________________ [insert name of person whom lien is claimed against],
upon the following described real property:
[insert street address of real property]
[insert legal description of real property]
The sum of ______________ dollars ($_______________) together with interest thereon at the highest rate
permitted by applicable law from the __________ day of ___________________, __________ [insert the date
balance became due], is due claimant for the following work, equipment, and/or materials furnished by
[insert a detailed description of all work, equipment, material used in the completion of this project, including cost
Work on the property began on or about the _________ day of ___________________, ___________.
[choose one of the following statements]
Work was last performed on the property on the _______ day of ________________________, _______.
Work was substantially completed on the __________ day of ___________________________, ________.
SIGNED AND DELIVERED this ________ day of ________________, _______ by the within named
[insert name of maker] [signature of maker]
I, the undersigned, do hereby say that I am the claimant named in the foregoing Mechanic’s Lien; I have
read said claim of Mechanic’s Lien and know the contents thereof; the same is true of my own
knowledge. I am authorized to execute this Claim of Lien.
Executed on the ___________ day of _________________________, __________ at
_____________________________ [city], Wyoming.
[signature of claimant]
STATE OF WYOMING
COUNTY OF ______________________, SS: _______________
______________________ [insert name of claimant], being sworn, says:
Subscribed and sworn to before me, under oath, this _____ day of ________________________, _________
by _____________________________ [insert name of claimant] who acknowledges that the matters and
things alleged in the foregoing Mechanic’s Lien are true and correct to the best of his/her knowledge as
My Commission expires: