Claimant Enter the Claimant's Name The Claimant (Mechanic) is the person releasing their rights to placing a lien over the property. Customer The Customer is the person who is responsible to pay the bill in order to satisfy the lien. Enter the Customer's Name Owner Is the customer also the owner of the property that is being improved? Is the customer also the owner of the property that is being improved? YesNo Select "No" if the customer is a general contractor working for an owner of a property and "Yes" if it's solely the owner that the work is being done for without any middle man. Owner's Name Job Location Enter the address of the property involved in the project or job: Street Address Address Line 2 City Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming State ZIP Code Do you wish to include the property's legal description? Do you wish to include the property's legal description? YesNo Enter the legal description: Through Date The Through Date is the date when the services offered by the contractor should have been completed. Enter the Through Date Lien Type If the lien is Conditional, it means that the claimant (contractor/mechanic) is using this document to induce a payment from the customer and upon evidence of payment, the lien will go away. If Unconditional, it means that the claimant is using this form to show that they have received the final payment from the customer. What type of Waiver and Release form will this document be? Select OneConditional Waiver and Release FormUnconditional Waiver and Release Form Name of Claimant's Financial Institution Enter the amount that the Claimant has received from the customer $ Notary Will a Notary be signing this Mechanic's Lien? Will a Notary be signing this Mechanic's Lien? YesNo The purpose of a Notary is to show proof that the signatures are real and true. By the Notary signing the document, it confirms the accuracy of the signatures. Finding a Notary can be easy as most financial institutions such as your local bank will have a notary on hand. In which State and County will this Mechanic's lien be signed by the Notary? County State Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming Date Do you know the date when this form will be signed? Do you know the date when this form will be signed? YesNo Enter the Signature Date Signature Would you like to e-Sign this document now? Would you like to e-Sign this document now? YesNo If you wish to sign this document at a later time or using a handwritten signature after it is printed, select No. Claimant's Signature Clear Please draw your signature. Please write your signature to the area above. Next Save Save and finish later
