STATE OF _________________________
COUNTY OF _______________________
NOTICE is hereby given that ______________________, does hereby claim a lien on the following property situated in _________________ County, __________________, to-wit:
SEE ATTACHED LEGAL DESCRIPTION
The aforesaid lien is in the amount of $__________________ , which is the unpaid balance for goods, materials and services furnished in the construction of the improvements on the above described real property, at the request of the owner of said property, __________________________.
Suit has not been filed. The Contract has not been filed or recorded.
The undersigned claims a contractors and materialmens lien under the provision of Section __________, _______________ Code of __________, as amended.
WITNESS my signature this the ______ day of _______________, 20____ .
SWORN TO AND SUBSCRIBED before me on this ____ day of ____________, 20 ____.
MY COMMISSION EXPIRES:
State Specific Liens-Mechanic Forms
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