Mechanics Lien Claim (Multi-State)

CLAIM OF MECHANICS LIEN

Before you use this: Confirm that the property state permits this instrument for this claimant and project. Use the state's mandatory form or differently named notice if required; identify the exact lien law, preliminary notice, sworn-text, recording, service and enforcement requirements before signing. The Florida citation in the sources illustrates one state's claim requirements; it does not govern other states.

Recording requested by: [CLAIMANT OR AUTHORIZED PRESENTER]

Return recorded instrument to: [NAME AND MAILING ADDRESS]

Property state and county: [STATE; COUNTY]

Recording office: [COUNTY CLERK / TOWN LAND RECORDS / OTHER OFFICE REQUIRED BY LAW]

Statutory claim authority and claimant class: [CURRENT STATUTE, SECTION, AND ELIGIBLE CLASS]

Required statutory warning or prescribed heading: [INSERT EXACT WORDING REQUIRED BY SELECTED STATE OR STATE NONE AFTER REVIEW]

1. Claimant and contracting chain

Claimant's full legal name: [NAME]

Claimant's address for notice and process: [ADDRESS]

Claimant's role: [ORIGINAL CONTRACTOR / SUBCONTRACTOR / SUPPLIER / LABORER / DESIGN PROFESSIONAL / OTHER ELIGIBLE ROLE]

Person who contracted with or employed Claimant: [FULL LEGAL NAME AND ADDRESS]

Direct contractor, if different: [NAME AND ADDRESS / NONE]

Other contracting tier needed by law: [NAMES, RELATIONSHIPS AND ADDRESSES / NONE]

Owner or reputed owner's name and address: [FULL LEGAL NAME AND TITLE-RECORD ADDRESS]

2. Property and interest claimed

Street address and parcel identifier: [ADDRESS; PARCEL NUMBER]

Complete legal description: Exhibit A, attached and incorporated into this Claim.

Owner's or other covered interest against which lien is claimed: [SPECIFIC INTEREST, TITLE HOLDER, AND STATUTORY BASIS]

Improvement or project: [NAME, LOCATION AND DESCRIPTION]

3. Work, dates and notices

Claimant furnished the following qualifying labor, services, equipment or materials for the improvement described above: [SPECIFIC DESCRIPTION, INCLUDING ANY SPECIALLY FABRICATED ITEMS STATED SEPARATELY IF REQUIRED].

First furnishing date: [__/__/____]

Last qualifying furnishing date: [__/__/____]

Contract completion, cessation, notice of completion or other relevant filing event: [EVENT, DATE AND RECORDING REFERENCE / NONE]

Required preliminary notice: [NOTICE TYPE AND STATUTE / NOT REQUIRED FOR THIS CLAIMANT UNDER CITED SECTION]. If given, it was delivered on [DATE] to [EACH REQUIRED RECIPIENT] by [METHOD], with proof [REFERENCE]. Additional monthly or tier-specific notices were [LIST DATES, RECIPIENTS AND METHOD / NOT REQUIRED UNDER SOURCE].

4. Amount lawfully claimed

The amount claimed excludes any charge not lienable under [CURRENT STATE STATUTE AND SECTION]. Any contract finance charge, interest or fee is included only if separately identified and authorized by that law: [ITEM, AMOUNT AND AUTHORITY / NONE].

5. Claim of lien

Claimant claims a mechanics or construction lien, to the extent provided by [STATE STATUTE AND SECTIONS], against the property interest identified in Section 2 for $[UNPAID LIENABLE AMOUNT] arising from the work or materials identified above. This Claim is made for the actual unpaid amount after the payments and credits shown in Section 4.

Additional content required by selected state law: [INSERT EXACT REQUIRED FIELD OR STATEMENT / NONE]

Claimant or authorized agent signature: ________________________________

Printed name, title and authority: [NAME, ROLE AND BASIS OF AUTHORITY]

Date signed: [__/__/____]

Verification and notarial act

I, [SIGNER], [SWEAR / AFFIRM] that I am [CLAIMANT / AGENT ACQUAINTED WITH THESE FACTS] and that the factual statements and amount in this Claim are true to the extent required by [STATE VERIFICATION STATUTE OR PRESCRIBED FORM].

Signer signature before officer: ________________________________

State and county of notarial act: [STATE AND COUNTY]

Subscribed and sworn to or affirmed before me on [__/__/____] by [SIGNER NAME AND CAPACITY], identified by [METHOD ACCEPTED BY APPLICABLE LAW].

Notarial officer signature: ________________________________

Printed name, commission and seal: [DETAILS REQUIRED FOR RECORDING]

Exact state-required jurat, acknowledgment or witness text, if different: [INSERT BEFORE EXECUTION]

Exhibit A — legal description

[INSERT COMPLETE RECORDABLE LEGAL DESCRIPTION; ATTACH ALL PAGES]