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Fillable Form Mechanic's Lien

This is a template used to create and fill out a Mechanic's Lien form which is a document used to ensure that the professional is paid for services that they provided and for which they were not paid.

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What is a Mechanic's Lien?

A Mechanic’s Lien is used by claimants and real property owners in the United States to create a guarantee of payment for contractors, builders, and construction companies that build, create, or repair different kinds of structures.

Mechanic's Liens can also be extended to suppliers of materials, subcontractors, and companies who are able to cover building repairs as well. This legal document is used by claimants and real property owners to ensure that the men who are working are paid before anyone else in the event of a sudden liquidation.

How to fill out a Mechanic’s Lien?

Get a copy of Mechanic's Lien template in PDF format.

Claimants and mechanics in the United States can write their own Notice of Mechanic's Lien Form or download a PDF copy from a website that offers document templates. For convenience, they can also fill out the Notice of Mechanic's Lien Form electronically on PDFRun.

To fill out a Notice of Mechanic's Lien Form, you must provide the following information:

State of

Enter the state where you are currently residing.

County of

Enter the county where you are currently residing.

Date

Enter the current date when this Mechanic’s Lien was entered into.

Day

Enter the current day when this Mechanic’s Lien was entered into.

Month

Enter the current month when this Mechanic’s Lien was entered into.

Year

Enter the current year when this Mechanic’s Lien was entered into.

Name of Mechanic

Enter the full legal name of the mechanic.

Location of Mechanic

Enter where the shop of the mechanic is located.

License Number of Mechanic

Enter the license number of the mechanic.

Sum of Construction Lien

Enter the sum of the construction lien for labor, services, materials, and equipment furnished for improvement to the real property in U.S. dollars.

Owner of Real Property

Enter the full legal name of the owner of the real property that will be improved by the mechanic.

Location of Real Property

Enter the place where the owner’s real property is located.

City of

Enter the city where the owner’s real property is located.

State of

Enter the state where the owner’s real property is located.

Legal Description of Real Property

Enter the legal description of the owner’s real property and include all important details.

Parties Involved in the Lien

Mark the appropriate box which corresponds to the other party involved in this Mechanic’s Lien. You may select:

  • The owner
  • Other - Enter the full legal name of the other party involved in this Mechanic’s Lien.

Date of Contract Entry

Enter the date when this Mechanic’s Lien was entered into and mark the box if this will be attached as Exhibit A.

Name of Property

Enter the name of the property that will be improved using the mechanic’s labor, services, materials, and equipment.

Total Amount for Services

Enter the total amount for the services the mechanic will provide in U.S. dollars.

First Day of Work on the Property

Enter the day when the claimant has first worked on the property.

Last Day of Work on the Property

Enter the day when the claimant has last worked on the property.

As of the Effective Date

Mark the appropriate box which corresponds to the payment you have received. You may select:

  • Has not received any payment
  • Has received payment
    • Enter the total amount you have received in U.S. dollars.

Total Balance

Enter the total balance of the amount that is owed after deducting all just credits and offsets in U.S. dollars. Then, mark the box if the interest rate per annum from the completion date is still due to you as of the effective date.

Interest Rate

Enter the interest rate of the total balance per annum from the completion date.

Notice of Lien

Mark the appropriate box which corresponds to the delivery of the notice of lien. You may select:

  • Not applicable
  • The notice of lien was given to the owner on the said date, a copy of which is attached hereto as Exhibit B.
    • Enter the date when the notice of lien was delivered to the owner.

Assignee of the claim

Mark the appropriate box which corresponds to the assignee of the claim. You may select:

  • Not applicable
  • The claimant was assigned this claim from the assigned person
    • Enter the full legal name of the person who has assigned this claim to you

If ever the owner has failed to pay the balance due despite the demands and requests for payment, you may declare that the claim amount is justly due to you.

Claim Amount

Enter the total claim amount due to you in U.S. dollars.

You must declare that the contents of this Mechanic’s Lien are true and correct to the best of your knowledge once you have affixed your signature as of the effective date.

Claimant signature

Affix your signature.

Claimant full name

Enter your full legal name.

Verification

State of

Enter the state where you are currently residing.

County of

Enter the county where you are currently residing.

Name of Assigned Person

Enter the full legal name of the person assigned to verify your foregoing claims and know about the facts stated in this Mechanic’s Lien.

Title of Assigned Person

Enter the title of the person assigned to verify your foregoing claims and know about the facts stated in this Mechanic’s Lien.

Signature

Have the assigned person affix his or her signature.

Date

Enter the current date of signing.

Notary of Acknowledgement

State of

Enter the state where you are currently residing.

County of

Enter the county where you are currently residing.

Date of Acknowledgement

Enter the date when this foregoing instrument was acknowledged before the notary public.

Day

Enter the day when this foregoing instrument was acknowledged before the notary public.

Month

Enter the month when this foregoing instrument was acknowledged before the notary public.

Year

Enter the year when this foregoing instrument was acknowledged before the notary public.

Signature

Have the notary public affix his or her signature.

Notary Public

Have the notary public enter his or her full legal name.

Commission Expiry Date

Have the notary public enter the date when his or her commission will expire.

Proof of Service

You must declare under the penalty of perjury that you are at least 18 years of age and that you have served a copy of the Mechanic’s Lien by registered mail, certified mail, or first class mail, evidenced by a certificate of mailing, postage prepaid address to the following:

Owner or Purported Owner

Enter the full legal name of the owner or purported owner.

Address of Owner or Purported Owner

Enter the address of the owner or purported owner.

Date of Service

Enter the date of the service.

Signature

Affix your signature.

Date

Enter the current date of signing.

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