NOTICE OF CLAIM OF LIEN –
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]
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 _______________.