NOTICE UNDER MECHANIC's LIEN LAW

To ........................ Esquire,

Clerk of the ............... and all others to whom it may concern:

PLEASE TAKE NOTICE, That (1.) .......... residing at .......... in the .......... and .......... residing at .......... in the .......... have and claim a lien for the principal and interest of the price and value of the labor and material hereinafter mentioned, upon the house, building and appurtenances, and upon the lot, premises and parcel of land upon which the same may stand, or be intended to stand, hereinafter mentioned, pursuant to the provisions of an Act of the Legislature of the State of New York, entitled "An Act in relation to liens" constituting Chapter Thirty-three of the Consolidated Laws, the same having become a law February 17, 1909, and being Chapter Thirty-eight of the Laws of 1909, and acts amendatory thereof.

(2.) The name of the owner of the real property against whose interest therein a lien is claimed is........ and the interest of the owner as far as known to the lienor is ...........................................................

(3.) The name of the person by whom the lienor was employed is.........

The name of the person to whom he furnished materials is...........

(4.) The labor performed was ..........................................

The labor to be performed is.......................................

The material furnished was ........................................

The material to be furnished is ....................................

The agreed price and value of said labor is .........................

The agreed price and value of said material is ......................

(5.) The amount unpaid to the lienor for such labor and material is........

(6.) The time when the first items of work were performed was ..........

and the time when the first items of material were furnished was ............

The time when the last items of work were performed was............

and the time when the last items of material were furnished was ............

(7.) The property to be charged with a lien is described as follows:

..........................................................................................................................................

..........................................................................................................................................

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Dated .............. 19....

COUNTY OF............ss.:............being duly sworn, says that he is .......... the claimant mentioned in the foregoing notice of lien, that he has read the said notice and knows the contents thereof, and that the same is true of h.. own knowledge, except as to the matters therein stated to be alleged on information and belief and that as to those matters he believes it to be true.

Sworn before me, this..........

day of.........................19.............