NOTICE OF MECHANIC'S LIEN UNDER LIEN LAW To the Clerk of the County of______________ and all others whom it may concern: PLEASE TAKE NOTICE, that _______________________________, as lienors have and claim a lien on the real property hereinafter described as follows: (1) The names and residences of the lienor(s) are ________________________________________, ______________________________ New York ________, being a corporation composed of corporation ___________________________________________, 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(s), is __________________________________. (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 was ______________________________________________________ the 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 is $_____________and the agreed price and value of 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 is $________________ and for said materials furnished is $________________. American LegalNet, Inc. www.FormsWorkflow.com The amount unpaid to the lienor for material actually manufactured but not delivered to the real property is $________________ The total amount unpaid is $________________ (10) The total amount claimed for which this lien is filed is $________________ (11) The time when the first item of work was performed was __________________ and the time when the first material furnished was ____________________. (12) The time when the last item of work was performed was ____________________ and the time when the last item of material furnished was ________________________ (13) The property subject to the lien is situated in the County of _________________________, City of _________________, and known by the address _________________________________ ______________________________________________ Section _____________ Block_______ Lot ____________. 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:________________________________________ (sign name above, print it below) American LegalNet, Inc. www.FormsWorkflow.com VERIFICATION - CORPORATION STATE OF NEW YORK, COUNTY OF _____________________ ss.: __________________, 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 on this _______ day of ________________________ ______________________________ Notary Public VERIFICATION - INDIVIDUAL STATE OF NEW YORK, COUNTY OF _____________________ ss.: being duly sworn, says that deponent is (one of the co-partnership named in the within notice of lien and) 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 on this _______ day of ________________________ __________________________________ ______________________________ Notary Public American LegalNet, Inc. www.FormsWorkflow.com Affidavit of Service of Notice of Mechanic’s Lien on Owner, Attorney or Agent STATE OF NEW YORK, 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 _________________________________________________________________ by delivering a true copy to said owner personally. Deponent knew the person so served to be the owner. as the owner could not be found, by delivering a true copy to the agent attorney of the owner. by leaving it at the last known place of residence of the owner in the city or town in which the real property or some part thereof is situated, with a person of suitable age and discretion. by depositing a true copy of same, enclosed in a certified registered mail, postpaid, properly addressed wrapper, in an official depository of the United States Postal Service in New York State. as the owner has no last known place of residence in the city or town in which the real property or some part thereof is situated, or the owner could not be found, and has no agent or attorney, by affixing a true copy thereof conspicuously on such property, at m. (between the hours of nine o’clock in the forenoon and four o’clock in the afternoon). as the owner is a corporation, by personally delivering a true copy and leaving it with the president vice-president secretary clerk cashier treasurer director managing agent of the corporation. as the owner is a corporation, and no officer of the corporation could be found within the state, by affixing a true copy conspicuously on such property at ______m. (between the hours of nine o’clock in the forenoon and four o’clock in the afternoon). as the owner is a corporation, by depositing a true copy of same, enclosed in a certified registered mail, postpaid, properly addressed wrapper, in an official depository of the United States Postal Service in New York State. ____________________________________ Sworn to before me on this ______ day of _______________, _______ ________________________ NOTARY PUBLIC NOTE: The Notice of Mechanic's Lien must be served 5 days before or no later than 30 days after filing. (Lien Law sec. 11.) American LegalNet, Inc. www.FormsWorkflow.com Affidavit of Service by Certified Mail STATE OF NEW YORK, 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 contractor subcontractor assignee legal representative 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 on 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-b, must be filed in the appropriate County Clerk’s Office within 35 days of filing of the Notice of Mechanic’s Lien. Mechanic’s Lien Notice of Lien Claimant: _______________________________ Residence: ______________________________ Business Address _________________________ _______________________________ against Amount: $_______________ Filed: __________________________ Owner: ________________________________ Contractor: _____________________________ Premises: ___________________________ ___________________________ Block: _________ Lot: _________ Attorney(s) for Lienor: _____________________ Post Office Address and Telephone Number: ________________________________________ ________________________________________ American LegalNet, Inc. www.FormsWorkflow.com