Notice of Intent to Lien Form

Notice Of Intent to Lien


[_____] PROPERTY OWNER (Name & Address)




[_____] PRIME CONTRACTOR(Name & Address)




[_____] HIRING PARTY(Name & Address of party hiring NOTIFYING PARTY, or if aboveprovided, indicate this)




[_____] OTHER _______________________(Name & Address, if any)





NOTIFYING PARTY (Name & Address)





PROPERTY where services were performed: (Provide Legal Property Description)





Description of Labor, Materials, Services, etc. provided to the Property by Claimant (“SERVICES”):






AMOUNTS DUE AND UNPAID: $_____________

PLEASE TAKE NOTICE that the above-identified NOTIFYING PARTY has and claims a lien against the above-described PROPERTY, together with all buildings and improvements thereon, said property being owned by the above-identified PROPERTY OWNER.

The lien is claimed to secure the sum above-identified as the AMOUNTS DUE AND UNPAID, said amount representing the amount due to the NOTIFYING PARTY after applying all just credits, payments and offsets. Said amount is the balance due and owing to the NOTIFYING PARTY for services it provided to the PROPERTY, as above-described as the SERVICES. The SERVICES were provided to the PROPERTY at the request of the above-identified HIRING PARTY. The SERVICES were used in the construction upon and/or improvements to the PROPERTY.

PLEASE TAKE FURTHER NOTICE that if the said amount (the claim) is not paid within ten (10) days from service of this notice, the NOTIFYING PARTY will file with the Circuit Clerk for the county where the PROPERTY is located, in the State of Arkansas, a sworn statement of amount due, as described in this Notice, pursuant to Ark. Code. Ann § 18-44-117. This sworn statement of amount due is commonly referred to as a Mechanic’s Lien.

PLEASE TAKE FURTHER NOTICE that under Ark. Code Ann. § 18-44-128, if the NOTIFYING PARTY does file a lien, and is not thereafter paid within twenty (20) days after the filing of the lien, and is forced to sue to enforce the claim, the Court will allow the NOTIFYING PARTY reasonable attorneys’ fees in addition to any other relief to which the NOTIFYING PARTY is entitled.


Agent for Notifying Party

Signed by

Notice sent to the above listed parties on _____/_____/20____
















I, __________________________, declare that on the _____ day of _____________, 20____, I served copies of the attached Notice of Intent to Lien to the following parties:

[______]   Property Owner

[______]   Hiring Party

[______]   Prime Contractor

[______]   Other (___________________)

[______]   I served the attached document:

[______]   By First Class Certified or Registered Mail service, postage prepaid, properly addressed and labeled, and return receipt requested

I declare under penalty of perjury that the foregoing is true and correct.

Dated: _____ day of _____________, 20____


Sworn to and subscribed before me on the above-inscribed date.


Notary Public



Signed by









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