Warning!
THIS LEGAL DOCUMENT REFLECTS THAT A CONSTRUCTION LIEN HAS BEEN PLACED ON THE REAL
PROPERTY LISTED HEREIN. UNLESS THE OWNER OF SUCH PROPERTY TAKES ACTION TO SHORTEN THE
TIME PERIOD, THIS LIEN MAY REMAIN VALID FOR ONE YEAR FROM THE DATE OF RECORDING, AND
SHALL EXPIRE AND BECOME NULL AND VOID THEREAFTER UNLESS LEGAL PROCEEDINGS HAVE BEEN
COMMENCED TO FORECLOSE OR TO DISCHARGE THIS LIEN.
CLAIM OF LIEN
(Section 713.08, Florida Statutes)
STATE OF FLORIDA
COUNTY OF GADSDEN
BEFORE ME, personally appeared ________________________________________________,
who was duly sworn and says that she/he is (the lienor herein/the agent of the lienor herein)
_________________________________________________________________, whose address is
_________________________________________________; and that in accordance with a contract with
___________________________________________________________, lienor furnished labor, services or
materials consisting of _______________________________________________, on the following
described real property located in
Gadsden County, Florida:
owned by ______________________________________________________________, of a total value of
$______________________, of which there remains unpaid $______________________, and furnished the
first of the items on _______________________, _______; and the last of the items on
__________________________, _______; and that lienor served his Notice to Owner on
__________________________, _______, by ____________________________________________, and
(if the lien is claimed by one not in privity with the owner) that the lienor served copies of the Notice on the
contractor on __________________________, _______, by ________________________, and on the
subcontractor on __________________________, _______, by_________________________.
_________________________________________
______________________________________
print or type name
State of Florida
County of Gadsden
The foregoing instrument was acknowledged before me this ___ day of __________, 20 ___, A. D., who is personally
known to me or who has produced __________________________ as identification, and who did/did not take an oath.
Prepared By: _______________________________ _____________________________________________
Notary Public
_________________________________________________
_________________________________________________ _____________________________________________________
Print or type name
My Commission Expires:
