AFFIDAVIT FOR MECHANIC'S LIEN State of Ohio, County of , ss: , whose address is , being first duly sworn, says that , the lien claimant, furnished certain material or performed certain labor or work furtherance of improvements located on or removed to the land hereinafter described, in pursuance of a certain contract, with , the owner, , whose address is . The first of the labor or work was performed or material was furnished on the day of , 20 . The last of the labor or work was performed or material was furnished on the day of , 20 , and there is justly and truly due , the lien claimant, therefor from , the owner, over and above all legal setoffs, the sum of dollars ($ ), for which amount , the lien claimant, claims a lien on the land, building, or leasehold, of which is or was the owner, part owner, or lessee, as the case may be, which property is described as follows: Sworn to before me and subscribed in my presence this day of , 20 . ________________________________ , Notary Public American LegalNet, Inc. www.FormsWorkflow.com