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

(GRANTEE)

versus

(GRANTOR)

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:

1. THE LIEN CLAIMANT (Hereinafter “Claimant”)

2. DATE ON WHICH THE CLAIMANT BEGAN TO PERFORM LABOR, PROVIDED PROFESSIONAL SERVICES, SUPPLY MATERIALS OR EQUIPMENT

3. THE PARTY INDEBTED TO THE CLAIMANT

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:

6. NAME OF THE OWNER OR REPUTED OWNER

7. THE LAST DATE ON WHICH LABOR WAS PERFORMED; PROFESSIONAL SERVICES WERE FURNISHED, OR EQUIPMENT WAS FURNISHED:

8. PRINCIPAL AMOUNT WHICH THE LIEN IS CLAIMED

 

© 2012 Express Lien, Inc. dba Zlien

State of

County of

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.

Signature:

Signed By:

ACKNOWLEDGEMENT

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: ________________

Notary Signature:

Print Notary Name:

NOTARY PUBLIC in and for the State of

Commission Expires:

 

 

 

 

 

 

© 2012 Express Lien, Inc. dba Zlien
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