Lien Form

Full Name of the Lienholder

Full Address of the Lienholder

Full Name of the Property Owner (if known)

Full Address of the Property Owner (if known)

Full Legal Description of the Property where the Work was Provided

Brief Description of the Work Done or Material Supplied, or the Lien is for Wages Owed

Full Name of the Person to Whom the Work or Materials were Provided

Full Address of the Person to Whom the Work or Materials were Provided

If the Lien is for Oil or Gas

Date of Last Day When the Work or Materials were Provided

Amount Claimed

Address for Service of the Lienholder

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[field id="Full Name of the Lienholder"]

[field id="Full Address of the Lienholder"]

[field id="Full Name of the Property Owner (if known)"]

[field id="Full Address of the Property Owner (if known)"]

[field id="Full Legal Description of the Property where the Work was Provided"]

[field id="Brief Description "]

[field id="Full Name of the Person "]

[field id="Full Address of the Person "]

[field id="If the Lien is for Oil or Gas"]

[field id="Date of Last Day"]

[field id="Amount Claimed"]

[field id="Address for Service of the Lienholder"]