Affidavit for Mechanic's Lien (O.R.C.1311.06) State of Ohio, County of ___________ss: ______________________________________________________whose address is ____________________________________________________________________, Being first duly sworn, says that ________________________________________, the lien claimant, furnished certain material of performed certain labor or work in the furtherance of improvement located on or removed to the land hereinafter described, in pursuance of a certain contract, with____________________________, the owner, part owner, lessee, original contractor, subcontractor, or other person, as the case may be, whose address is ________________________________________________. The first day of 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 therefore from ___________________________________, the owner, part owner, lessee, original contractor, subcontractor, or other person, as the case may be, 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: Revised 06/09 American LegalNet, Inc. www.FormsWorkFlow.com ______________________________ Signature of Affiant _______________________________ Printed Name of Affiant STATE OF OHIO COUNTY OF SUMMIT Before me, a notary public, in and for said County, personally appeared above named _____________________________________________________________________ who acknowledge that ________did sign the foregoing instrument and that the same is ______ free act. In testimony whereof I have hereunto set my hand and official seal, this ______ day of _______________, 20____. ______________________________ Notary Public My commission expires:___________ This instrument was prepared by: ___________________________ Section 1311.07 provides that: "Any person filing an affidavit pursuant to section 1311.06 of the Revised Code [Affidavit of Mechanic's Lien] shall serve a copy of the affidavit on the owner, part owner, or lessee of the improved property or his designee, within thirty days after filing the affidavit. If the affidavit cannot be served in accordance with section 1311.19 of the Revised Code, then the person shall serve the copy by posting it in some conspicuous place on the premises of the improved property within ten days after the expiration of the thirty days." Revised 06/09 American LegalNet, Inc. www.FormsWorkFlow.com