Subcontractors Mechanics Lien Form

IInstrument Prepared By
And Recording Requested By:

 

 

 

 

 

 

 

 

 

 

Space Above For Recorderʼs Use

SUBCONTRACTORʼS CLAIM OF LIEN

In the Office of the Recorder of Deeds

County of ______________, State of Illinois

Claimant: (Name and Address)

 

 

 

Hiring Party: (Name and Address)

 

 

 

Property Owner: (Name and Address)

 

 

 

Prime Contractor: (Name and Address)

 

 

 

Property. The real property upon which the Project is 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"):

 

 

 

County:

State of Illinois

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Legally Described As:

 

 

 

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

 

 

 

 

Amount Due and Claimed:

 

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

$

THE CONTRACT Type of Contract:

Date of Contract: ______________

Date of Last Furnishing Labor and/or Materials: ______________

Total Amount of Contract: $______________

THE UNDERSIGNED LIEN CLAIMANT, above-identified as the CLAIMANT, hereby files a claim for a Mechanics Lien against the above-identified PROPERTY OWNER, and all other parties having or claiming an interest in the real estate above-identified as the PROPERTY; a claim for a Mechanics Lien is further asserted against the aboveidentified PRIME CONTRACTOR.

The CLAIMANT asserts that as of the above-indicated date of contract, the PROPERTY OWNER owned the property above-described as the PROPERTY.

Upon information and belief, the CLAIMANT asserts that the PROPERTY OWNER, or one knowingly permitted by it to do so, entered into a contract with the PRIME CONTRACTOR wherein the PRIME CONTRACTOR was to provide labor, materials,

© 2012 Express Lien, Inc. dba Zlien

equipment, and/or other services for the construction of repairs, alterations and/or improvements upon the PROPERTY.

The CLAIMANT contracted with the HIRING PARTY by entering into the contract above-identified and described as the CONTRACT. The contract was such that the CLAIMANT would provide the above-described SERVICES to the PROPERTY for the total cost of the contract, above-identified. The CLAIMANT states that it did so provide the above-described SERVICES.

The CLAIMANT last furnished labor and/or materials to the PROPERTY on the date above-indicated.

After giving the PROPERTY OWNER, PRIME CONTRACTOR and all other interested and relevant parties all just credits, offsets and payments, the balance unpaid, due and owing to the CLAIMANT is above-identified as the AMOUNT OF CLAIM; for which, with interest, the CLAIMANT claims liens on the PROPERTY and improvements.

Notice has been provided to the PROPERTY OWNER, and persons otherwise interested in the above described PROPERTY, as to the status of the undersigned as subcontractor as provided by the Mechanics Lien Act (III Rev Stat ch 82 ¶ 5, 24 (1991); 770 ILCS 60/5 and 60/24 (1992)).

Signature of Claimant, and Verification

State of Illinois
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, and that I have read the foregoing Claim of Lien, know the contents thereof, and 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,

Print Name:

Dated:

© 2012 Express Lien, Inc. dba Zlien

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 is the Claimant and executed this document in that capacity

Notary Public

© 2012 Express Lien, Inc. dba Zlien
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