MECHANIC'S LIEN KNOW YE, that _________________________, a Connecticut corporation with a business address of __________________________________, CONNECTICUT, herein referred to as "Lien Claimant", acting herein by __________________________, ITS DULY AUTHORIZED PRESIDENT does hereby certify that the Lien Claimant furnished materials and rendered construction services for the development activities of certain property known as _______________________, situated in the TOWN of _________________, CONNECTICUT which property is owned by ________________________ bounded and described in Volume _____ at Page ____, of the __________ Land Records and more fully described in the notice set forth below. The value of the materials and services so furnished and rendered amounts to the sum of ___________________________________ AND 00/100 ($_______________) DOLLARS, as nearly as the same can be ascertained, which sum with interest from ________________, 2008, is now justly due from said _______________________________ to Lien Claimant. Lien Claimant commenced to furnish materials and render services on ______________________, 2008, and ceased furnishing such materials and rendering such services on _________________, 2008. On _______________________, the following notice in writing was given to said _____________________________________ in words and figures following, to wit: TO: ________________________________________ TAKE NOTICE that on ___________________, 2008, the undersigned commenced to furnish materials and render surveying and engineering services for the development activities on a lot of land owned by you, in the site development of such lot or plot of land, situated in the TOWN of ________________, County of ______________, and State of Connecticut, known and designated as _________________________ bounded and described as follows: SEE ATTACHED SCHEDULE A ATTACHED HERETO AND MADE A PART HEREOF Being the property conveyed to ____________________ by __________________________ by Warranty Deed dated _______________________ and recorded in Volume ________ at Page ____ of the ____________ Land Records, and further conveyed to ___________________________ by __________________ by Warranty Deed dated ___________________ and recorded in Volume _____ at Page ____ of said Land Records. TAKE FURTHER NOTICE THAT THE UNDERSIGNED INTENDS TO CLAIM A American LegalNet, Inc. www.FormsWorkFlow.com MECHANIC'S LIEN THEREFORE on said land, lot or plot of land and building(s). Dated at _____________, Connecticut, on ________, 2008. ________________________________________ __________________________________________ By _______________________ ITS DULY AUTHORIZED PRESIDENT The notice was duly served upon said ____________________________ as required by statute. WHEREFORE, Lien Claimant now by these presents claims a lien on said building(s) and the land on which the building(s) stand(s), as security for the payment in full of the aforesaid sum with interest, and to this end the Lien Claimant now makes and lodges with the Town Clerk of ________________ in which said building(s) and land are situated this certificate within ninety days from the date of ceasing to render such services and furnish such materials. IN WITNESS WHEREOF, Lien Claimant has executed this instrument on ____________. ________________________________________ __________________________________________ By _____________________________ ITS DULY AUTHORIZED PRESIDENT STATE OF CONNECTICUT ss. ________________ COUNTY OF _____________ Personally appeared ___________________________., signer of the foregoing certificate and made solemn oath that the facts stated therein are true, and that the said sum of ___________________________________ AND 00/100 ($_______________) DOLLARS, as nearly as the same can be ascertained, with interest, is justly due, before me, on ______________. __________________________________________ Commissioner of the Superior Court American LegalNet, Inc. www.FormsWorkFlow.com NOTICE OF MECHANIC'S LIEN TO: _____________________________ _____________________ _____________________ TAKE NOTICE that on ___________________________, the undersigned commenced to furnish materials and rendered construction services for the development activities on a lot of land owned by you, in the site development of such lot or plot of land, situated in the TOWN of ________________________, County of _________________, and State of Connecticut, known and designated as ______________________ bounded and described as follows: SEE ATTACHED SCHEDULE A ATTACHED HERETO AND MADE A PART HEREOF Being the property conveyed to ________________________ by _____________________ by Warranty Deed dated ________________________ and recorded in Volume _______ at Page _____ of the _________________ Land Records, and further conveyed to ________________ and __________________ by _____________________ by Warranty Deeds dated _____________ and recorded in Volume _______ at Page _____ of said Land Records. TAKE FURTHER NOTICE THAT THE UNDERSIGNED INTENDS TO CLAIM A MECHANIC'S LIEN THEREFORE on said land, lot or plot of land and building(s). Dated at __________________, Connecticut, on ____________________. _______________________________________ __________________________________________ By _____________________________ ITS DULY AUTHORIZED PRESIDENT American LegalNet, Inc. www.FormsWorkFlow.com