Mechanics Lien Form
Instrument Prepared By
And Recording Requested By:
Space Above For Recorder’s Use
CLAIM OF LIEN
O.C.G.A. § 44-14-361
In the State of Georgia, County of ________________
____________________, a _______________, hereinafter the Claimant, claims a lien in the amount of $___________ on the structure and the premises or real estate on which it is erected or built, owned by ____________________, whose mailing address is_______________________________________________, for satisfaction of a claim which became due and payable on this date, __________________, for providing the following materials, services, labor and/or equipment:
The municipal address of the property is as follows:
The legal description of the property is as follows: State of Georgia, County of
THIS CLAIM OF LIEN EXPIRES AND IS VOID 395 DAYS FROM THE DATE OF FILING OF THE CLAIM OF LIEN IF NO NOTICE OF COMMENCEMENT OF LIEN ACTION IS FILED IN THAT TIME PERIOD. FURTHER, IN ACCORDANCE WITH O.C.G. § 44-14-368, THE PROPERTY OWNER MAY CONTEST THIS LIEN BY FILING A NOTICE OF CONTEST OF LIEN.
Within two business days after the filing for record of this claim of lien, a copy of this Claim of Lien was sent by certified mail to the record owner of the property and the prime contractor, if any, at the below address
State of Georgia, County of
___________________, Claimant, or authorized agent for the Claimant, being sworn says: I am the Claimant (or authorized agent for the Claimant), I have read or heard the foregoing claim, know the contents thereof, and based upon my belief (and/or the information provided to me by the Claimant), believe the same to be true and correct and that the claim of lien is not frivolous and is made with reasonable cause, and is not clearly excessive under penalty of perjury. So signed by Claimant (or authorized agent of the Claimant to the right), and sworn to and subscribed before Notary Public undersigned on this _______________.
Authorized Agent of