Sample Notice of Claim of Lien Letter


The undersigned applicant hereby claims a lien under Section [section code number] of the Civil Code of the State of [state name] and hereby announces the following:
1. That a clarification of the property mandatory to be charged with the lien is:

– [Describe property]


2. That applicant is payable a sum of $[amount]
3. That the name of the owner(s) of the property is/are:

– [state name of owner(s)]

4. That the [name of the person] by whom applicant was employed or to whom applicant supplied the materials is/are:

– [state customers]

5. That a general declaration of the type of work done and/or materials supplied by applicant, or both is:

-[Work executed and/or materials supplied]
Dated:  [date]

Signed: _____________________________________
[Applicant name]

State of [state name], County of [County name]:

I, __________________________________, do hereby confirm that on this

______ day of ________, __________, appear before me in person

known to be the person(s) who executed the preceding document.


Notary Public in and for the State of _________________.

My commission expires _______________.

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