Mechanics Lien Form
IInstrument Prepared By
And Recording Requested By:
Space Above For Recorderʼs Use
CLAIM OF LIEN
Washington RCW 60.04 et seq | Filed in ______________ County
Notice is hereby given that the person named below claims a lien pursuant to chapter 60.04 RCW. In support of this lien the following information is submitted:
4. THE PROPERTY AGAINST WHICH A LIEN IS CLAIMED IS LOCATED AT THE FOLLOWING MUNICIPAL ADDRESS:
5. LEGAL DESCRIPTION OF THE PROPERTY IS AS FOLLOWS:
8. PRINCIPAL AMOUNT WHICH THE LIEN IS CLAIMED
I, ___________________, the undersigned, being of lawful age and being first duly sworn upon oath, do state that I am the Claimant named herein, that I have read the foregoing Notice of Claim of Lien, know the contents thereof, and I have knowledge of the facts, and certify that based thereupon, upon my information and belief the foregoing is true and correct, and that I believe them to be true.
I certify that I know or have satisfactory evidence that_________________________ is the person who appeared before me, and said person acknowledged that he/she signed this instruction, on oath stated that he/she was authorized to execute the instrument and acknowledged it as the Claimant, to be the free and voluntary act of such party for the uses and purposes mentioned in this instrument, and that the corporation does not have a seal. In Witness Whereof I have hereunto set my hand and affixed my official seal this day and year first above written.
Given under my hand and official seal this date: ________________
Print Notary Name:
NOTARY PUBLIC in and for the State of