Abstract: Mechanics Lien Form

Mechanics Lien Form

Company Name: *

Your Name: *

Business Address: *

Office Phone: *

Office Fax: *

Email: *

Owner Of The Property To Be Liened:

Name And Address Of The Person By Whom You Were Employed:

Name And Address Of The Person With Whom The Contract Was Made:

Labor Performed:

Material Furnished:

Materials Manufactured But Not Delivered:

Agreed Price Of Labor Performed:

Agreed Price Of Material Furnished:

Agreed Price Of Materials Manufactured But Not Delivered:

Amount Unpaid For Labor Performed:

Amount Unpaid For Material Furnished:

Amount Unpaid For Material Actually Manufactured But Not Delivered:

Total Amount Unpaid:

First Day At Job Site:

Last Day At Job Site:

Exact Address Of Location To Be Liened (incl. Apt #):

Property Type (i.e. Pvt House, Condo)

Today's Date: *

( * Required Field )

That said labor and materials were performed and furnished for and used in the improvement of the real property herein described. That eight (8) months (four [4] months if a single family dwelling) have not elapsed dating from the last item of work performed, or from the last items of materials furnished, or since the competion of the contract, or since the final performance of the work, or since the final furnishing of the materials for which this lien is claimed.

We request that Abstract Associates of New York, Inc. file a Mechanics Lien against the property indicated above with the information that we have provided. False/Misleading information will render this Mechanic's Lien useless; therefore, we agree to assume responsibility in the event that the information provided is incorrect. We agree to pay Abstract Associates of New York, Inc. $250 for this service.

Please include your payment of $250 per lien. Please note that no action will be taken regarding your lien unless payment is received in full.