CLAIM OF MECHANIC'S LIEN

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					                            CLAIM OF MECHANIC'S LIEN



STATE OF )

COUNTY )

I, the undersigned, whose address is __________________________________,
affirm that in accordance with a contract between myself and
_________________________, I furnished labor, services or materials
consisting of:




of a total value of ____________________ Dollars ($ ) of which there remains
unpaid amount of _________________ Dollars ($ ), on the following described
real property located at ________________________________ in _____________
County, State of _____________________:

which is owned by ___________________. I furnished the first of the labor,
service, or materials on the ____ day of _______________, 20__ .

Notice of this Claim have been served on:

__________________________________ by _____________________________ at
____________________________________ on _________________________.

__________________________________ by _____________________________ at
____________________________________ on _________________________.




__________________________________

Signature




Subscribed and sworn before me on this ___ day of ___________, 20__.

WITNESS my hand and seal.

____________________________________ My commission expires:

Notary public

				
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posted:3/9/2008
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