Michigan Construction Lien Claim Form

Michigan Construction Lien Claim Form
Use this form to provide the information needed to prepare a construction lien claim for a Michigan property.
Claimant Information
Claimant Full Legal Name
Business Name (if applicable)
Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Property and Project Details
Property Owner or Owner's Representative Name
First NameMiddle NameLast Name
Michigan Property Address Where Work Was Performed
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Project Name or Description
Date Claimant Started Work
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date Claimant Last Provided Labor, Materials, or Services
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Lien Claim Details
Amount Claimed as Unpaid
Description of Labor, Materials, or Services Provided
Basis of Claim
Notice and Filing Information
Date Notice Sent
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Recipient Name
Recipient Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Certification and Signature
Printed Name
First NameMiddle NameLast Name
Title or Relationship to Claimant
Signature
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Date Signed
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: