Notice of Personal Liability
Sworn Statement and notice of intention to hold mechanics lien
State of Indiana | County of_________________
Attn: Property Owner: As provided in the latest entry in the county auditors transfer books:
Claimant is a:
Amount of Claim
Services, labor, materials, equipment and/or work and all supervision related thereto, provided by the Claimant (Services):
LAST DATE Labor and/or Materials Furnished:
Hiring Party: As provided in the latest entry in the county auditors transfer books:
The Serviceswere supplied in the improvement and/or construction of real property described as follows (Services):
State of Indiana
Legal Property Description:
ATTN: PROPERTY OWNER. YOU ARE HEREBY NOTIFIED that the above-identified CLAIMANT intends to hold a Mechanics Lien on the real estate above-described and identified as Property, and on improvements thereon, and any and all leashold interests exhisting therein.
The CLAIMANT intends to hold a Mechanics Lien on the Property for the amount above-identified as the AMOUNT OF CLAIM, plus attorney fees, interest and all costs associated therewith. These sums are owed to the CLAIMANT by the above-referenced HIRING PARTY, for labor, materials, equipment and/or services (above-identified, SERVICES), last furnished to and for the Property on the above-identified LAST DATE.
The undersigned individual executing this instrument, having been duly sworn upon his or her oath, under the penalties of perjury, hereby states that CLAIMANT intends to hold a mechanics lien upon the above described Property, and the facts and matters set forth in this Sworn Statement and Notice of Intention to Hold Mechanics Lien are true and correct
State of Indiana
Before Me, undersigned Notary Public in and for said County and State, personally came and appeared ____________________, CLAIMANT, and acting for and on its behalf, and s/he being first duly sworn by me upon his/her oath, and before me and subscribed in my presence, acknowledged the execution of the foregoing Sworn Statement and Notice of Intention to Hold Mechanics Lien, and that based on his/ her information, knowledge and belief, further stated that the facts and matters herein set forth are true and correct, and executed the same.
Witness my hand and Notarial Seal, this__________________.
Name of Claimant: