Claim Of Lien - California (Page 2 of 3) in pdf

Claim Of Lien - California Page 2

The lien is claimed for the following labor, services, equipment or materials:

Amount due after deducting all just credits and offsets: $___________________

Name & Address of person or entity to whom Claimant furnished labor, services, equipment

and/or materials:

Name of Claimant:

Verification: I, the undersigned, as a disclosed and

___________________________________

authorized Agent of the Claimant, state that I have

read the foregoing Claim of Lien, that I have been

provided information regarding the facts and contents

Signature:

therein, and that based thereupon, I declare under

penalty of perjury under the laws of the State of

California that the foregoing is true and correct.

____________________________________

________________

Signature:

, Agent for Claimant

Signed by: _______________________

____________________________________

________________

, Agent for Claimant

Signed by: _______________________

Page 2 of 3

Claim Of Lien - California Page 2