STATE OF SOUTH CAROLINA ) ) NOTICE AND CERTIFICATE OF COUNTY OF BEAUFORT ) ) MECHANICS LIEN BY: (PLAINTIFF) ) ) TO: (DEFENDANTS) ) NOTICE IS HEREBY GIVEN that ____________________________________(Plaintiff) , is due the sum of ______________________and _____/00 Dollars from _________________________________(defendant) , a Statement of just and true Account of said indebtedness, with all just credits given, being attached and made a part hereof as Attachment ____. That said indebtedness is due the undersigned, _____________________________________ for ______________________ services authorized by the above said by way of _______________________. These service fees are now delinquent as to the Real Estate hereafter described, and that _________________________________________ (Defendants) are the owners of such described Real Estate. That, as shown by the attached Statement of Account, the described account is now delinquent. That, by virtue thereof, by the service and filing of this Notice and Certificate of Lien, and pursuant to the provisions of _______________________, the undersigned has and claims a lien to secure the payment for the debt so due and the costs of enforcing said lien upon the following described Real Property: SEE ATTACHMENT __ (or describe here) Sworn to before me on ______ day ) The Forgoing is true of my own knowledge. of ___________, year ______. ) ) FOR: ___(Plaintiff)__________________________ ) ___________________________________________) BY: _______________________________________ NOTARY PUBLIC FOR: ) Print Name & Title: My Commission Expires: ) NOTE: This form does not constitute the rendering of legal advice. It is intended for information purposes only, andsu ibs sntiotut tea for legal advice. Consult an Attorney licensed to practice law in the State of South Carolina on legal matters. >>>> 2 ATTACHMENT ___ STATEMENT OF ACCOUNT Personally appeared before me, a Notary Public for _________________________, the undersigned who deposes and declares as follows: 1. He is an agent for ___(Plaintiff) _____________________________________________________. 2. ____(Plaintiff)__________________________________ furnished the below listed services & materials to ___(Defendant) ___________________________________ on the dates indicated. 3. The amount due and owing from __(Defendant) ________________________ is as follows: INVOICE NO. INVOICE DATE SERVICE/MATERIALS PROVIDED _AMT. OWED_ Copies of invoices are attached hereto. Sworn to before me on _____ day ) FOR: ___(Plaintiff) _________________________________ Of _____________, year ______, ) ) BY: _____________________________________________ __________________________________ ) Print Name & Title: NOTARY PUBLIC FOR: My Commission Expires: