AFFIDAVIT OF LIEN AGAINST PROPERTY OF EMPLOYER (O.R.C. Section 1311.35)
County of ____________ ss. State of ______________
Now comes __________, having been first duly sworn, and, pursuant to Ohio Revised Code section 1311.25, states and affirms as follows: 1. ______________, whose addresses are _______, was at all times relevant hereto an employee of _______ within the meaning of Ohio Revised Code sections 1311.34, 1311.35 and 1311.36. 2. _____________, provided the labor described below to _________ in the course of his/her employment by _____________ and is owed ___________ from ________ for said laborer. 3. The amount, kind and value of the labor giving rise to the claim described in paragraph (2) above are: _________________________ _________________________ 4. ____________ hereby claims a lien against all real property of __________, wherever located, pursuant to Ohio Revised Code sections 1311.34, 1311.35, and 1311.36 in order to secure payment of the claim described in paragraph (2) above. Further affiant sayeth naught. ________________________________ _____________________ Sworn to before me and subscribed in my presence this _____ day of __________, 20____.