Lien and/or Payment Bond Preparation Information
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required field
Person or Company Claiming Lien/Bond:
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Address:
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Telephone:
x
Fax:
Contact Person:
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Title:
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Real Property Improved:
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Address:
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City:
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Lot Number:
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County:
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Directions:
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Name of Owners of Real Property:
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Name of Company or Person with whom you contracted for the furnishing of labor and/or materials:
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Name(s) of any subcontractor(s) with whom you contracted to improve the real property up to the name of the general contractor:
Name of General Contractor:
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Address of General Contractor:
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Name of 1st tier subcontractor:
Address of 1st tier subcontractor:
Name of 2nd tier subcontractor:
Address of 2nd tier subcontractor:
Name of 3rd tier subcontractor:
Address of 3rd tier subcontractor:
Date on which labor and/or materials were first furnished upon or for the real property:
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Date on which labor and/or materials were last furnished upon or for the real property:
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General description of the labor performed or materials furnished:
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Amount claimed:
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$
By checking this box, you confirm that you are indeed familiar with the facts from which this matter and/or claim arises, and that (s)he has read the above lien/bond preparation in full, and that to his/her personal knowledge, information and belief, the matters and things stated therin are true, and that (s)he authorizes a lien/bond be filed in accordance and pursuant with the information provided therin.
Which attorney would you like to submit this form to?
James R. Vann
Paul A. Sheridan
Nancy E. Hannah
Jim Beck
Chad Cochran
Your email address: