To: …………………………………..
You will please take notice that the undersigned has performed work and labor under a contract with ……………………………… who was general contractor with you (or who was subcontractor with …………………………….., who was general contractor with you) in the erection and construction (or removal, repair, improvement or otherwise, as the case may be) of a certain building (or other structure or improvement) on real estate known as (here insert an adequate and ascertainable description of the real estate to be charged) and that said work and labor was f the kind, was performed on the dates, for the purposes and at the prices, as shown in the following itemized account thereof:
(Here insert itemized account)
You are further notified that 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