Claim of Mechanics Lien Form

IInstrument Prepared By
And Recording Requested By:

 

 

 

 

 

 

 

 

 

 

Space Above For Recorderʼs Use

CLAIM OF LIEN

WARNING! THIS LEGAL DOCUMENT REFLECTS THAT A CONSTRUCTION LIEN HAS BEEN PLACED ON THE REAL PROPERTY LISTED HEREIN. UNLESS THE OWNER OF SUCH PROPERTY TAKES ACTION TO SHORTEN THE TIME PERIOD, THIS LIEN MAY REMAIN VALID FOR ONE YEAR FROM THE DATE OF RECORDING, AND SHALL EXPIRE AND BECOME NULL AND VOID THEREAFTER UNLESS LEGAL PROCEEDINGS HAVE BEEN COMMENCED TO FORECLOSE OR DISCHARGE THIS LIEN.

Lienor (Name and Address)

 

 

 

 

Property Owner (Name and Address)

 

 

 

 

Hiring Party Name and Address of person or entity to whom the Claimant furnished labor, services, equipment and/or materials:

 

 

 

 

Services The lien is claimed for the following labor, services, equipment or materials:

 

 

 

 

Property Liened (Property)

 

 

State of Florida

County:

 

 

Legal Description:

 

 

Date Services First Furnished:

 

 

Date Services Last Furnished:

 

 

img Date Preliminary Notice to Owner
Sent to Property Owner:

img Date Preliminary Notice to Owner
Sent to Prime Contractor:

img Date Preliminary Notice to Owner
Sent to Subcontractor:

© 2012 Express Lien, Inc. dba Zlien
Amount Due and Unpaid:

$

Amount of Total Contract

$

Before Me, the undersigned Notary Public, personally came and appeared _____________________, the Lienor, or the attorney of the Lienor, who was duly sworn and says that the information on the first page of this Claim of Lien is accurate and true. That in accordance with a contract with the Hiring Party, the Lienor Furnished the labor, services, and/or materials above-identified as the Services, said Services were furnished on the above-described Property.

The Property is owned by the Property Owner

The total contract price between the Hiring Party and the Lienor is above-identified as the Amount of Total Contract. Of this amount, the above-identified Amount of Total Claim remains unpaid.

The Services were first furnished to the Property on the above-identified Dates Services First Furnished, and last furnished to the Property on the above-identified Dates Services Last Furnished.

The Lienor delivered the required preliminary Notice to Owner on the above-indicated dates to the above-indicated parties, if any

 

Signed:

 

, Lienor

Signed by

Date:

Sworn to (or affirmed) and subscribed before me, Notary Public, on __________________, by the Lienor.

 

Notary Public

Commission expires:

 

(Seal)

© 2012 Express Lien, Inc. dba Zlien
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