Affidavit Claiming a Lien Form
Affidavit Claiming a Lien Form document sample
Shared by: tow41088
AFFIDAVIT CLAIMING LIEN STATE OF TEXAS: COUNTY OF: NOTE: THIS IS NOT A LIEN. THIS IS ONLY AN AFFIDAVIT CLAIMING A LIEN. BEFORE ME, a notary public in and for the State of Texas, on this day personally appeared the undersigned, who being by me duly sworn, on oath states: 1. My name is _______________, I am the _____________ (partner, president, credit manager, etc.) of _______________ ("Claimant") and am authorized to make this affidavit on its behalf as the sworn statement of its claim. 2. Claimant furnished labor and/or materials for the improvement of the following described land in ___________________ County, Texas: 3. The name and last known address of the person to whom the labor and/or materials were furnished for such improvement is: Name: Address: The labor and/or material was furnished under a written contract which is attached hereto and made a part hereof (if applicable). 4. The name and last known address of the original contractor for such improvement is: Name: Address: 5. The name and last known address of the owner or reputed owner of the land and improvements thereon is: Name: Address: 6. The kind of work done and/or material furnished by Claimant is ________________________________________________________. Claimant is hereby asserting a claim for work performed and/or materials furnished in the following months: ___________________. 7. The amount unpaid for such work and/or materials and which is now due and owing to claimant is $_______________, which amount is true, correct, and just, with all just and lawful offsets, payments, and credits known to affiant allowed. 8. Claimant's name is ______________ and its mailing address (and physical address, if different) is _______________________. THIS IS A 2-PAGE FORM.