PAUL D. PATE Secretary of State State of Iowa Submitter information: Name, Address, City, State, Postal Code MECHANIC'S NOTICE AND LIEN REGISTRY SUBMITTER INFORMATION MNLR Number (if applicable): ________________________________________________________________ (May be found by searching the MNLR database at https://sos.iowa.gov/mnlr/search) Email address: ___________________________________________________________________________ Telephone: _______________________________________________________________________________ * Print or type information. Illegible or incomplete documents will be refused and returned. * All fields on Submitter Information form are required and must be returned with documents. * Mechanic's liens are to be filed electronically or by U.S. mail pursuant to Iowa Code section 572.34(8). SECRETARY OF STATE Business Services Division Lucas Building, 1st Floor Des Moines, IA 50319 Phone: (515) 281-5204 Fax: (515) 242-5953 Website: sos.iowa.gov American LegalNet, Inc. www.FormsWorkFlow.com SI 1-15 PAUL D. PATE Secretary of State State of Iowa MECHANIC'S NOTICE AND LIEN REGISTRY COVER PAGE FOR A PAPER SUBMISSION OF A MECHANIC'S LIEN - RESIDENTIAL Applicable items noted in 1A or 1B must be completed. Illegible or incomplete documents will be refused and returned. The Submitter Information form, a copy of the Mechanic's Lien and Statement of Account must be attached and submitted with this cover page. THIS COVER PAGE IS NOT A SUBSTITUTE FOR THE ACTUAL MECHANIC'S LIEN. Paper size of attachments must be 8 ½ by 11. 1A. MNLR NUMBER: ____________________, complete items #3, 5b, 5c, 7, sign and date. (MNLR number may be found by searching the MNLR database at https://sos.iowa.gov/mnlr/search) If MNLR number provided, the following will be prefilled from the Mechanic's Notice and Lien Registry. It is your responsibility to verify the accuracy of the information currently on record before filing this form. a. Claimant Posting the Mechanic's Lien: Name and Mailing address; b. Information for Property to be Charged with Mechanic's Lien: County, Other counties, Street address or location, Tax parcel ID number, Legal description. c. Mechanic's Lien Information: Date when material was first furnished or labor first performed; and d. Additional Information: General Contractor / Owner Builder name, Mailing address, Telephone. OR; 1B. MARK THE FOLLOWING, complete items #2 through #7, sign, date and attach a copy of legal description: Labor was performed on or materials were supplied to this residential construction project on or before December 31, 2012. 2. CLAIMANT POSTING THE MECHANIC'S LIEN: Name: ______________________________________________________________________________________ Mailing address: ______________________________________________________________________________ City: __________________________ State: ___________ Postal Code: ______________ Country: ____________ Email: _______________________________________________________________________________________ 3. CURRENT PROPERTY OWNER(s): (attach additional pages if needed) Name: _______________________________________________________________________________________ Mailing address: _______________________________________________________________________________ City: __________________________ State: ____________ Postal Code: _____________ Country: ____________ 4. INFORMATION FOR PROPERTY TO BE CHARGED WITH MECHANIC'S LIEN: County: _______________________ Other counties: ________________, _________________, ________________ Street Address or location: ________________________________________________________________________ City: _____________________________ State: IA Postal Code: _________________________________________ (or nearest city if not street address) Tax parcel ID number: (attach additional pages if needed)________________________________________________ Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com MLR 1-15 Legal description: COPY OF LEGAL DESCRIPTION MUST ACCOMPANY THIS FORM. PAPER SIZE OF ATTACHMENTS MUST BE 8 ½ x 11. 5. MECHANIC'S LIEN INFORMATION: a. Date when material was first furnished or labor first performed: __________________________________________ b. Date when material was last furnished or labor was last performed: ______________________________________ c. Amount owed to Claimant: ______________________________________________________________________ 6. ADDITIONAL INFORMATION: General Contractor / Owner Builder name: ____ ________________________________________________________ Mailing address: ________________________________________________________________________________ City: ___________________________ State: ___________Postal Code: _____________Country________________ Telephone: ____________________________________________________________________________________ A COPY OF THE MECHANIC'S LIEN AND STATEMENT OF ACCOUNT MUST BE ATTACHED AND SUBMITTED WITH THIS COVER PAGE. THIS COVER PAGE IS NOT A SUBSTITUTE FOR THE ACTUAL MECHANIC'S LIEN. ALSO ATTACH A COPY OF THE LEGAL DESCRIPTION. PAPER SIZE OF ATTACHMENTS MUST BE 8 1/2 X 11. 7. CERTIFICATION: If Original MNLR Number provided in 1A or if 1B is marked - I certify under penalty of perjury and pursuant to the laws of the state of Iowa that the preceding is true and correct. Signature: _____________________________________________ Date: _____________________________________ If the MNLR document you have selected was not posted by you, submission of this form is your verification that it is your intent to post a document based on the information posted by another MNLR user. FEE: $40.00 SECRETARY OF STATE Business Services Division st Lucas Building, 1 Floor Des Moines, IA 50319 Phone: (515) 281-5204 Fax: (515) 242-5953 Web site: sos.iowa.gov MLR 1-15 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com