[COURT NAME]
[COUNTY], [STATE]

[LIEN CLAIMANT NAME], )
Claimant, )
) Case No. [CASE NUMBER]
v. )
)
[DEBTOR/RESPONDENT NAME], )
Respondent. )

NOTICE OF LIEN

1. Lien claimant: [NAME], [ADDRESS], [PHONE].
2. Debtor or party against whom the lien is asserted: [NAME], [ADDRESS].
3. Property or proceeds subject to lien: [PROPERTY DESCRIPTION/CASE PROCEEDS].
4. Basis for lien: [STATUTE/CONTRACT/JUDGMENT], dated [DATE].
5. Amount claimed: $[AMOUNT] plus interest and costs as allowed by law.
6. Supporting documents: [LIST ATTACHMENTS].

Claimant requests that this notice be recorded and that the lien be enforced as permitted by law.

Signature

text
Dated: [DATE]

______________________________
[NAME]
[TITLE]
[ADDRESS]
[PHONE]
[EMAIL]

Proof of Service

I certify that on [DATE], I served this Notice of Lien on [RECIPIENTS] via [METHOD OF SERVICE].

text
______________________________
[NAME]