[Name and address]

　　NOTICE OF CLAIM OF LIEN

　　The undersigned claimant hereby claims a mechanic`s lien under section_______of the Civil Code of the State of

　　_________ and hereby declares the following：

　　1.  That a statement of claimant`s demand， after deducting all just credits and offsets， in the sum of $        .

　　2.  That the name of the owner[s]， or reputed owner[s] of the property is [are]：

　　3.  A general statement of the kind of work done or materials furnished by claimant， or both is：

　　[insert]

　　4.  That the name[s] of the person[s] by whom claimant was employed or to whom claimant furnished the materials is [are]

　　5.  A description of the property sought to be charged with the lien is：  [enter full legal description here].

　　DATED：  ________________

　　_______________________ [Signature of Claimant]