Certificate of Mechanics Lien Form
Instrument Prepared By And Recording Requested By:
Space Above For Recorderʼs Use
CERTIFICATE OF MECHANICS LIEN
TO THE CLERK OF THE ______________, STATE OF CONNECTICUT
Claimant: (Name and Address)
Property Owner: (Name and Address)
Services: The lien is claimed for the following labor, services, equipment or materials:
Amount Due: The amount which is justly due nearly as the same can be ascertained, plus interest and attorney's fees, if applicable:
Commencement Date: The date in which the rendering or services, labor and/or materials commenced:
The Prime Contractor:
Property Liened: Buildings standing thereon known as the following property address:
State of Connecticut
And Legal Property Description:
THIS IS TO CERTIFY THAT the above-identified Claimant, in accordance with a certain contract between it and the above-identified Hiring Party, and by the consent of the owner of the premises above-described and identified as the Property Liened, has a Lien under the statutes in such cases made and provided on the Property Lien, in the state of Connecticut.
The Lien is in the amount above-identified as the Amount, which is justly due. The Lien is filed against the above-identified Property Owner, who upon information and belief is the fee interest in said premises as recorded. The Lien is for the rendering of services, labor and/or materials in connection with the construction, erection, renovation, and raising of said buildings and the improvement of said premises. The rendering of services, labor and/or materials commenced on the date above-identified as the Commencement Date.
IN WITNESS WHEREOF, the undersigned is duly authorized on behalf of the Claimant, does hereby solemnly and formally declare and make oath and affidavit that the facts set forth herein are true and therefore has set his/her hand seal of the Claimant, if a corporation, on the date inscribed above his/her signature.
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Before me, on __________________, personally appeared _________________, whose title with ______________________ is __________________, signer of the foregoing Certificate, duly acknowledged the execution of the foregoing instrument, that he/she held the title set forth in said instrument, and that he/she signed said instrument on behalf of the above-identified Claimant, by proper authority, and he/she made solemn oath to the truth of said instrument and that the amount stated therein is justly due as nearly as the same can be ascertained.
Name of Claimant: (Company Name)