"AFFIDAVIT FOR MECHANICS' LIEN.
State of Ohio,
County of ________________________, ss:
____________________, whose address is ____________________, being first duly sworn, says that ____________________, the lien claimant, furnished certain material or performed certain labor or work in the furtherance of improvements 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 of the labor or work was performed or material was furnished on the ___________ day of _______________, _______ (year). The last of the labor or work was performed or material was furnished on the ________ day of ____________, ______(year), and there is justly and truly due ____________________, the lien claimant, therefor 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:
________________________________________________________________
________________________________________________________________
________________________________________________________________
______________________________
Sworn to before me and subscribed in my presence this ____________ day of ___________________, ______ (year).
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______________________________
_____________________________"
R.C. § 1311.06