Florida Claim of Lien

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Person Signing and Lienor

Person signing
Title / capacity

Company

Company Name
Street Address

City
ST
ZIP

Contract and Property

Contract with
Labor, services, or materials furnished
County where property is located
Property owner name
Legal description of real property
Property owner address
Total job value ($)
Unpaid balance ($)
First furnishing date
Last furnishing date

Notice Information

Complete the notice fields that apply to this lien. Leave non-applicable fields blank.

Notice to Owner date
Notice to Owner delivery method
Copy served on contractor date
Contractor delivery method
Subcontractor name and address
Copy served on subcontractor date
Subcontractor delivery method

Execution and Notary

County where document will be signed
Date of notarization
Notarization method
Name of person making statement

Document Prepared By & Return To

Use the company name and address entered above for this section

Name
Street address
City
State
ZIP code