Mechanics Lien Form

Instrument Prepared By
And Recording Requested By:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Space Above For Recorder’s Use

Statement of Mechanics Lien

(Mechanicʼs, Materialmanʼs or Professional Services)

Claimant: &(Name and Address)

 

 

 

 

Property Owner: &(Name and Address)

 

 

 

 

 

 

 

 

 

Property:
The real property upon which the Project was constructed is the following described parcel(s) of land, and includes any and all structures and improvements located thereon, to which are to be charged with this Lien (the "Subject Property"):

Address:

 

 

Legal Description:

 

 

 

 

The Project Name and/or Reference Is:

 

 

© 2012 Express Lien, Inc. dba Zlien

The Claimant furnished labor, materials, services, tools and/or equipment of the following general description at the Property (Services):

 

 

 

The party who hired the Claimant to perform the Services at the Property is (the “Hiring Party”): &(Name and Address)

 

 

 

Amount of Claim

After deducting just offsets and credits, and accounting for all change orders, the amount demanded in this lien by the CLAIMANT is: $

This amount shall accrue interest at the rate of 10.00% per annum as per A.R.S. §44-1201. Claimant shall be entitled to the fees for preparing this Lien, and foreclosing thereupon, as per A.R.S. § 33-995(E) and § 33- 998(B).

The Contract The Claimant provided the Services to the Property pursuant to a:

img Written Contract
Oral Contract

The Contract For written contracts, the terms of the same are available pursuant to a copy of the contract which is attached to this lien as Exhibit ____.

The Contract For oral contracts, the terms of the same are described as follows:

 

 

 

Commencement Date:

Claimant first furnished the Services to the Property on or around the following date:

Completion Date:

The completion of the project occurred on or about the following date:

Preliminary Notice Date:
A copy of the Preliminary Notice(s) and the proof of its mailing is attached to this lien claim as Exhibit ____, the Claimant delivered the Preliminary Notice(s) as per ARS § 32-922.01 on the following date(s):

© 2012 Express Lien, Inc. dba Zlien

The CLAIMANT provides that at the request of the HIRING PARTY, it providing the SERVICES to the PROPERTY, and that the AMOUNT OF CLAIM is due and owing to the CLAIMANT in full, after providing all offsets and just credits. The CLAIMANT demands a lien on the PROPERTY and all improvements thereupon in the AMOUNT OF CLAIM. The CLAIMANT provides this Notice of Claim of Lien to the County Recorderʼs office in duplicate copies, the first to be recorded with the County, and the second to be returned to the CLAIMANT to be served upon the Owner(s) or Reputed Owner(s) as per statutory standards.

Signature of Claimant, and Verification
State of Arizona
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, or an authorized agent of the Claimant appointed for the purposes of signing and filing this Notice of Claim of Lien, and that I have read the foregoing Notice of Claim of Lien, know the contents thereof, and I have been provided and thereby 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.

Claimant

Signed by Authorized and Disclosed Agent

Print Name:
Dated:

Sworn to and subscribed before me, undersigned Notary Public in and for the above listed State and County/Parish, on this _______________________, by _______________________, who is known to me, or satisfactorily proved to me, to be the person whose name is subscribed to this document, and who acknowledged that he/she executed this document in the capacity indicated for the principal named.

Notary Public
© 2012 Express Lien, Inc. dba Zlien
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