Affidavit for Mechanics Lien

(O.R.C.1311.06)

State of Ohio, County of Lake ss: whose address is , Bein first du!y sworn, says that , the !ien "!ai#ant, furnished "ertain #ateria! of $erfor#ed "ertain !a%or or work in the furtheran"e of i#$ro&e#ent !o"ated on or re#o&ed to the !and hereinafter des"ri%ed, in $ursuan"e of a "ertain "ontra"t, with , the owner, $art owner, !essee, ori ina! "ontra"tor, su%"ontra"tor, or other $erson, as the "ase #ay %e, whose address is . 'he first day of !a%or or work was $erfor#ed or #ateria! was furnished on the day of , (0 . 'he !ast of the !a%or or work was $erfor#ed or #ateria! was furnished on the day of , (0 , and there is )ust!y and tru!y due the !ien "!ai#ant therefore fro# , the owner, $art owner, !essee, ori ina! "ontra"tor, su%"ontra"tor, or other $erson, as the "ase #ay %e, o&er and a%o&e a!! !e a! setoffs, the su# of do!!ars, for whi"h a#ount, the !ien "!ai#ant, "!ai#s a !ien on the !and, %ui!din , or !easeho!d, of whi"h is or was the owner, $art owner, or !essee, as the "ase #ay %e, whi"h $ro$erty is des"ri%ed as fo!!ows:

Revised 06/09

Si nature of *ffiant +rinted ,a#e of *ffiant S'*'- O. O/0O CO1,'2 O. L*3Before #e, a notary $u%!i", in and for said County, $ersona!!y a$$eared a%o&e na#ed who a"know!ed e that did si n the fore oin instru#ent and that the sa#e is free a"t. 0n testi#ony whereof 0 ha&e hereunto set #y hand and offi"ia! sea!, this day of , (0 . ,otary +u%!i" 4y "o##ission e5$ires: 'his instru#ent was $re$ared %y:

Section 1311.07 provides that: Any person filing an affidavit pursuant to section 1311.06 of the Revised Code [Affidavit of Mechanics ien! shall serve a copy of the affidavit on the o"ner# part o"ner# or lessee of the i$proved property or his designee# "ithin thirty days after filing the affidavit. %f the affidavit cannot &e served in accordance "ith section 1311.1' of the Revised Code# then the person shall serve the copy &y posting it in so$e conspicuous place on the pre$ises of the i$proved property "ithin ten days after the e(piration of the thirty days.)