Claim Of Lien Form printable pdf download

Claim Of Lien Form

WARNING!

THIS LEGAL DOCUMENT REFLECTS THAT A CONSTRUCTION LIEN

HAS BEEN PLACED ON THE REAL PROPERTY LISTED HEREIN. UNLESS

THE OWNER OF SUCH PROPERTY TAKES ACTION TO SHORTEN THE

TIME PERIOD, THIS LIEN MAY REMAIN VALID FOR ONE YEAR FROM

THE DATE OF RECORDING, AND SHALL EXPIRE AND BECOME NULL

AND VOID THEREAFTER UNLESS LEGAL PROCEEDINGS HAVE BEEN

COMMENCED TO FORECLOSE OR TO DISCHARGE THIS LIEN.

CLAIM OF LIEN

State of _____________

County of ____________

Before me, the undersigned notary public, personally appeared _____, who was duly sworn and

says that she or he is (the lienor herein) (the agent of the lienor herein _____), whose address is

_____; and that in accordance with a contract with _____, lienor furnished labor, services, or

materials consisting of _____ on the following described real property in _____ County, Florida:

(Legal description of real property)

owned by _____ of a total value of $_____, of which there remains unpaid $_____, and

furnished the first of the items on _____,

, and the last of the items on _____,

; and

(year)

(if the lien is claimed by one not in privity with the owner) that the lienor served her or his notice

to owner on _____,

, by _____; and (if required) that the lienor served copies of the notice

(year)

on the contractor on _____,

, by _____ and on the subcontractor, _____, on _____,

(year)

by _____.

(Signature)

Sworn to (or affirmed) and subscribed before me this _____ day of _____,

, by

(year)

(name of

person making statement)

(Signature of Notary Public - State of Florida)

(Print, Type, or Stamp Commissioned Name of Notary Public)

Personally Known ____ OR Produced Identification ____

Type of Identification Produced ____________________

Claim Of Lien Form