Claim of Lien (Sample)
A validly recorded claim against property for payment for work done
CLAIM OF LIEN
State of _____
County of _____
Before me, the undersigned notary public, personally appeared _____, who was duly sworn and says that she or he is (the lienor herein) (the agent of the lienor herein _____), whose address is _____; and that in accordance with a contract with _____, lienor furnished labor, services, or materials consisting of _____ on the following described real property in _____ County, Florida: (Legal description of real property)
owned by _____ of a total value of $_____, of which there remains unpaid $_____, and furnished the first of the items on _____, (year) , and the last of the items on _____, (year) ; and (if the lien is claimed by one not in privity with the owner) that the lienor served her or his notice to owner on _____, (year) , by _____; and (if required) that the lienor served copies of the notice on the contractor on _____, (year) , by _____ and on the subcontractor, _____, on _____, (year) , by _____.
(Signature)
Sworn to (or affirmed) and subscribed before me this _____ day of _____, (year) , by (name of person making statement) .
(Signature of Notary Public - State of Florida)
(Print, Type, or Stamp Commissioned Name of Notary Public)