Mechanics Lien Release


O.C.G.A. § 13-10-63 (a)(2)

This is not a lien

Notice Sent to:

Prime Contractor:    (Name & Address)






Hiring Party

Name & Address of the party who contracted the party providing this notice.







Name and geographical location of the public improvement for which the labor or materials supplied:





Notice Sent by:

Notifying Party:    (Name & Address of party providing labor, materials, equipment, or services)






Description of labor or materials furnished to the Hiring Party:






Anticipated Value of Services or Contact Price:






In a ccordance with O.C.G.A. § 13 - 10 - 63(a)(2), the Notifying Party provides the prime contractor this notice. YOU ARE HEREBY NOTIFIED that the Notifying Party has been hired by the Hiring Party to provide the above - described Services to the above - identified Improvement. Th e anticipated value of the Services, or the contract price is above - identified as the Anticipated Value.

In the event the Notifying Party is not paid for the Services, the Notifying Party herein reserves its rights to assert a claim against the payment bo nd or security deposit on the project. This is not a lien.

Please further accept this Notice to Contractor to Make Claim Against Contractor, and Payment Bond or Security Deposit, as a formal demand that you provide to the Claimant the follow i ng: ( i) a ny Notice of Commencement filed for this project; and (ii) a copy of the payment bond for this project. This demand is being made pursuant to O.C.G.A. § 13 - 10 - 1.

Please deliver these materials to the Claimant at the following address:




Agent for Claimant

Signed by:



Proof of service Affidavit

I, __________________________, being duly sworn , deposes and says that I am over the age of 18 years old, and that on the _____ day of _____________, 20____, I served the attached Notice to Contractor to the following parties at these stated addresses:

[______]   Prime Contractor












I served the attached document:

[______]   By personally delivering the notice to the identified parties;

[______]   By First Class Certified or Registered Mail service, return receipt requested, postage prepaid.

State of

County of

Sworn to and subscribed before me, undersigned Notary Public, on the date inscribed to th e right of this verification.

Notary Public

Signed this ____ day of_________________, 20____.

Agent for Claimant

Signed by:


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