TO THE CLERK OF THE COUNTY OF , STATE OF NEW YORK AND ALL
OTHERS WHOM IT MAY CONCERN:
PLEASE TAKE NOTICE, that ,
lienor, residing at or having a principal place of residence at
in the County of , State of New York, pursuant to Section
17 of the Lien Law of the State of New York, hereby extends for a period of one year from the filing hereof,
that certain Notice of Lien filed in this office by said Lienor on ,
against the real property
located in , in the Town/City of ,
County of , State of New York, and being shown on the County Tax Map in
Section , Block , Lot and being more particularly bounded and described as follows:
The owner of said real property against whose interest therein the lien is claimed is
and the name
of the contractor is .
The amount of said lien is $
The above named Lienor requests that, pursuant to Section 17 of the Lien Law of the State of
New York, the aforementioned lien be re-docketed as of the date of the filing of this extension.
Dated:
VERIFICATION - CORPORATION
STATE OF , ss.:
COUNTY OF
, being duly sworn, says that deponent
is the of , herein, that deponent has read the foregoing notice of lien and knows the contents thereof, and that the same is true to deponent’s
own knowledge, except as to the matters therein stated to be alleged upon information and belief, and
that as to those matters deponent believes it to be true. The reason why this verification is made by
deponent is that deponent is an officer, to wit, the of
, which is a domestic corporation, and
deponent is familiar with the facts and circumstances herein.
The source of deponent’s information and the grounds of deponent’s belief as to all matters
therein stated upon deponent’s knowledge are as follows: books and records of the corporation.
Sworn to before me this
day of
Notary Public
VERIFICATION - INDIVIDUAL
STATE OF , ss.:
COUNTY OF
being duly sworn, says that deponent is
the lienor(s) mentioned in the foregoing notice of lien;
that deponent has read the said notice and knows the contents thereof, and that the same is true to deponent’s
own knowledge, except as to the matters therein stated to be alleged on information and belief, and that as to
those matters deponent believes it to be true.
Sworn to before me this
day of
Notary Public