To the Clerk of the County of and all others whom it may concern:
PLEASE TAKE NOTICE, that ,
as lienor has and claims a lien on the real property hereinafter described as follows:
(1) The names and residences of the lienor are ,
New York ,
being a corporation composed of shareholders, whose business address is at ,
, New York ,
and whose principal place of business is at , New York .
If a partnership, the names and addresses of the partners are
.
The name and address of lienor's attorney if applicable is
.
(2) The owner of the real property is and the interest of the
owner, upon information and belief of the lienor, is fee simple.
(3) The name of the person by whom the lienor was employed is
(4) The name of the person to whom the lienor furnished or is to furnish material or for whom
the lienor performed or is to perform professional services is .
(5) The name of the person with whom the contract was made is .
(6) The labor performed and material furnished was .
(7) The materials actually manufactured for but not delivered to the real property are
.
(8) The agreed price and value of the labor performed and the material furnished is
$.
The agreed price and value of the material actually manufactured but not delivered to the real
property is $ .
The total agreed price and value is $
(9) The amount unpaid to the lienor for said labor performed and materials furnished is
$.
That said labor and materials were performed and furnished for and used in the improvement of
the real property hereinbefore described. That 8 months (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 completion 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.
Dated:
BY:
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
Affidavit of Service of Notice of Mechanic’s Lien on Owner, Attorney or Agent
STATE OF , ss.:
COUNTY OF
The undersigned, being duly sworn, deposes and says that deponent is over 18 years of age and
on served the within Notice of Mechanic’s Lien
on
the owner, agent or attorney
at
Sworn to before me this
day of
NOTARY PUBLIC
NOTE: The Notice of Mechanic's Lien must be served 5 days before or no later then 30 days after filing.
Affidavit of Service by Certified Mail
STATE OF , ss.:
COUNTY OF
The undersigned, being duly sworn, deposes and says that deponent is over 18 years of age and
on the undersigned served the within Notice of Lien on
the
at
by depositing a true copy of same, enclosed in a certified mail, postpaid, properly addressed wrapper, in
an official depository of the United State Postal Service in New York State.
Sworn to before me this
day of
NOTARY PUBLIC
Note: A contractor or subcontractor must be served simultaneously or within 30 days after filing Notice of Mechanic's Lien. Proof of such service, pursuant to Lien Law Section 11-6, must be filed in the appropriate County Clerk's Office within 35 days of filing of the Notice of Mechanic’s Lien.
Note: Serve a copy of Notice of Mechanic’s Lien on contractor or subcontractor simultaneously or within 30 days after filing Notice of Mechanic's Lien. File proof of service with County Clerk within 35 days after Notice of Mechanic's Lien is filed. See Lien Law § 11-b.