RECORDED AT THE REQUEST OF:

AND AFTER RECORDING, RETURN TO:

___________________________________________
_
(NAME)

___________________________________________
_
(ADDRESS)

___________________________________________
_
(CITY, STATE, ZIP) FOR RECORDER’S USE ONLY

MECHANIC'S LIEN
(California Civil Code §3084)
The Undersigned, Claimant, hereby claims a Mechanic’s Lien upon the following described real property: .

Claimant furnished labor, materials, services, and/or equipment for the following: .

The labor, material, services, and/or equipment listed above were performed or furnished at: .

Claimant's demand, after deducting all just credits and offsets, is , plus interest at the rate of % per annum from .

The name of the person[s] by whom the Claimant was employed or to whom the Claimant furnished the labor,

material, services, or equipment is[are]: .

The name of the owner[s] or reputed owner[s] of the property is[are]: .

Dated: ______________ By: ____________________________________

***

VERIFICATION

I, the undersigned, say: I am the OWNER of the claimant of the foregoing mechanic's lien; I have read said claim of

mechanic's lien and know the contents thereof; the same is true of my own knowledge. I declare under penalty of perjury

that the foregoing is true and correct.

Executed on “insert Date” at “insert City”, “insert State”

Dated: ______________ By: ____________________________________