CLAIM OF LIEN | |
Notice is hereby given that on the ........... day of ............., 19 .........., | |
(name) | |
(address) | |
first provided labor or material for an improvement to | |
.................................................................., | |
(legal description of real property from notice of comencement) | |
the (owner) (lessee) of which property is .................................................................. | |
(name of owner or lessee from notice of commencement) | |
The last day of providing the labor or material was the ............ day of ................., 19 ........... | |
TO BE COMPLETED BY A LIEN CLAIMANT WHO IS A CONTRACTOR, SUBCONTRACTOR, OR SUPPLIER: | |
The lien claimant's contract amount, including extras, is $......................... . The lien claimant has received payment thereon in the total amount of $............................, and therefor claims a construction lien upon the above-described real property in the amount of $ ........................... | |
TO BE COMPLETED BY A LIEN CLAIMANT WHO IS A LABORER: | |
The lien claimant's hourly rate, including fringe benefits and withholdings, is $............................... . There is due and owing to or on behalf of the laborer the sum of $ .............................. for which the laborer claims a construction lien upon the above-described real property. | |
(lien claimant) | |
by | |
(signature of lien claimant, agent, or attorney) | |
(address of party signing claim of lien) | |
Date:....................... | |
State of Michigan | ) |
) ss. | |
County of ........... | ) |
Subscribed and sworn to before me this ............. day of ..................., 19 ........ | |
Signature of Notary Public | |
My commission expires: | |
Prepared by: | |
(name and address of party) |
MCL 570.1111