CLAIM OF LIEN
State of
County of
Before me, the undersigned notary public, personally appeared, who was duly sworn and says that he/she is the of, whose address is ; and that the following described motor vehicle:
(Description of motor vehicle)
owned by, whose address is, has accrued $ in fees for a reasonable tow, for storage, and for parking, if applicable; that the lienor served its notice to the owner, the insurance company insuring the motor vehicle notwithstanding the provisions of s. 627.736, Florida Statutes, and all persons of record claiming a lien against the motor vehicle on, (year) , by.
(Signature)
Sworn to (or affirmed) and subscribed before me this day of, (year) , by (name of person making statement) .
(Signature of Notary Public) (Print, Type, or Stamp Commissioned name of Notary Public)
Personally Known OR Produced as identification.
However, the negligent inclusion or omission of any information in this claim of lien which does not prejudice the owner does not constitute a default that operates to defeat an otherwise valid lien.
Fla. Stat. § 705.184