Notice of Mechanic’s Lien.
To: ………………………………..
You will please take notice that the undersigned ……………………………. has furnished and delivered to ………………………………………. who was a contractor with you (or subcontractor with ……………………….., who was a contractor with you, as the case may be) for use in the erection and construction (or repair, removal, improvement, as the case may be) of (here list the buildings or other structure or improvement to be charged) of the real estate known as (here insert an adequate and ascertainable description of the real estate to be charged) and the said materials were of the nature and were furnished on the dates and in the quantities and at the price as shown in the following account thereof:
(Here insert itemized account.)
You are further notified that t the undersigned has not been paid the sum of $………………………………..(or that there is still due and owing to the undersigned thereon the sum of $ ……………………….) and that he claims a lien upon your interest in the said lot (or tract) of land and upon the buildings, structures and improvements thereon, to secure the payment of the said sum.
STATE OF WEST VIRGINIA
COUNTY OF ………………………..
…………………………………….., being first duly sworn, upon his oath says that the statements in the foregoing notice of mechanic’s lien contained are true, as
he verily believes.
Taken, subscribed and sworn to before me this ……….. day of ………….., 20…..
My commission expires ………………………………………………………………………………..
…………………………..
Notary Public