Construction Lien Claim Form

Construction Lien Claim Form
Country/ State*
blanks* has on claimed a construction lien on the property shown below Type a label* in the amount of $blank*, for the value of the work, services, material or equipment provided in accordance with a contract with Type a label* for the work, services, materials, or equipment listed below:
The following is the amount payable for claimant's work, services, materials, or equipment delivered in connection with the improvement of the real property, and on which this lien claim is based:
Total Contract Amount:
Amendments to Contract
Total Contract Amount and Amendments to Contract
Less: Agreed upon credits (retain age)
Less: Contract Amount Paid to date
Less: Amendments to contract amount paid to date
Total reductions from contract amount and amendments to contract
TOTAL LIEN CLAIM AMOUNT
This construction lien is asserted against the blanks* as the owner of the Block specified tract or unit of land and premises Type a label* Lot,
blank*, according to the tax chart of the City of Type a label* County of Type a label* services, materials, or equipment were given for the betterment of which property of the aforementioned work.
The work, services, materials, and equipment were delivered in accordance with the provisions of a written contract datedblanks* betweenblank* and Type a label* .
The date on which the last work, service, material, or equipment for which payment is sought was completedblank* .
NOTICE TO REAL PROPERTY OWNERS

To satisfy the sum claimed in this claim, your real estate may be sold. Your real estate, on the other hand, cannot be sold until the facts and problems at the heart of this dispute are resolved in a court of law. By law, the lien claimant must file a lawsuit to enforce the claim.
If the claimant fails to commence an action in the Superior Court in the county where the real property is located to establish the lien claim, the claimant forfeits all rights to enforce the lien and is forced to discharge the lien of record:
1. Within one year of the last payment for the work, services, material, or equipment for which the lien claim was filed;
or
2. Within 30 days of receipt of written notice from the owner requiring the claimant to commence an action to establish the lien claim, by personal service or certified mail, return receipt requested.
You will receive property notice of the proceeding as well as an opportunity to contest the claim and present your case.
If the court of law enters a judgment against you in favor of the claimant filing this lien claim after you (and/or your contractor or subcontractor) have had the opportunity to oppose the lien claim, and you fail to pay the judgment, your real estate may be sold to settle the judgment.
SUBCONTRACTOR OR CONTRACTOR NOTICE

This lien has been registered with the county clerk and served on the real estate owner. This lien serves as notice to the owner that the real estate may be sold to fulfill this claim unless the owner pays the claimant the claimed sum.
By:*
Clear
REPRESENTATION AND VERIFICATION OF THE CLAIMANT

Claimant represents and certifies that:
1. the amount claimed herein is due and owing at the time of filing, in accordance with claimant's contract described in the Construction Lien Claim;
and
2. the amount claimed herein is due and owing at the time of filing, in accordance with claimant's contract described in the Construction Lien Claim. The work, services, materials, or equipment for which this lien claim was filed were solely for the purpose of improving the real property that is the subject of this lien claim.

3. This claim was filed within 90 days of the last date the work, services, materials, or equipment for which payment is sought was given.
4. I certify that the foregoing statements are true to the best of my knowledge, and I understand that if any of the foregoing statements are false, this construction lien claim will be void, and I will be liable for damages to the owner or any other person injured as a result of the filing of this lien claim.
By:*
Clear
Date Signed:*
MonthDayYear
Date
Should be Empty: