The memorandum, affidavit and notice required by § 43-7 shall be sufficient if substantially in form and effect as follows: Memorandum for Mechanic’s Lien Claimed by Subcontractor. Name of owner:........................................................... Address of owner:........................................................ Name of general contractor (if any):..................................... Name of claimant:........................................................ Address of claimant:..................................................... Contractor license or certificate number of claimant (if applicable):........................................................ Issuance date of license or certificate (if applicable):........................................................ Expiration date of license or certificate (if applicable):........................................................ If no contractor license or certificate number is included, the claimant certifies that such a valid license or certificate is not required by law for the work done for which the benefit of a lien is claimed. 1. Type of materials or services furnished:........................................................................................................... 2. Amount claimed: $...................................................... If any part of the Amount claimed is not due as of the date of this mechanic’s lien, identify the date or event upon which it will be due and the sum(s) to which the due date(s) or event(s) apply:........................... 3. Type of structure on which work done or materials furnished:....................................................................................... 4. Brief description and location of real property:................................................................................................... 5. Date from which interest on above amount is claimed: Date:.................... It is the intent of the claimant to claim the benefit of a lien.................................................(Name of claimant). Affidavit. State of Virginia, County (or city) of.................... to wit: I,.................... (notary or other officer) for the county (or city) aforesaid, do certify that.............., claimant, or................, agent for claimant, this day made oath before me in my county (or city) aforesaid that.................... is justly indebted to claimant in the sum of.............. dollars, for the consideration stated in the foregoing memorandum, and that the same is payable as therein stated. Given under my hand this the...... day of............, 20........................ (Notary Public or Magistrate, et cetera.) Notice. To.................... (owner). You are hereby notified that.................... (general contractor) is indebted to me in the sum of................ dollars ($..........) with interest thereon from the.......... day of.........., 20..., for work done (or materials furnished, as the case may be,) in and about the construction (or removal, etc.,) of a.................... (describe structure, whether dwelling, store, or etc.,) which he has contracted to construct (or remove, etc.,) for you or on property owned by you in the county (or city) of............., and that I have duly recorded a mechanic’s lien for the same. Given under my hand this the................ day of..........., 20.......................... (Subcontractor).
Memorandum for Mechanic’s Lien Claimed by Subcontractor. Name of owner: Address of owner: Name of general contractor (if any): Name of claimant: Address of claimant: Contractor license or certificate number of claimant (if applicable): Issuance date of license or certificate (if applicable): Expiration date of license or certificate (if applicable): If no contractor license or certificate number is included, the claimant certifies that such a valid license or certificate is not required by law for the work done for which the benefit of a lien is claimed. 1. Type of materials or services furnished: 2. Amount claimed: $ If any part of the Amount claimed is not due as of the date of this mechanic’s lien, identify the date or event upon which it will be due and the sum(s) to which the due date(s) or event(s) apply: 3. Type of structure on which work done or materials furnished: 4. Brief description and location of real property: 5. Date from which interest on above amount is claimed: Date: It is the intent of the claimant to claim the benefit of a lien. (Name of claimant). Affidavit. State of Virginia, County (or city) of to wit: I, (notary or other officer) for the county (or city) aforesaid, do certify that, claimant, or, agent for claimant, this day made oath before me in my county (or city) aforesaid that is justly indebted to claimant in the sum of dollars, for the consideration stated in the foregoing memorandum, and that the same is payable as therein stated. Given under my hand this the day of, 20. (Notary Public or Magistrate, et cetera.) Notice. To (owner). You are hereby notified that (general contractor) is indebted to me in the sum of dollars ($) with interest thereon from the day of, 20, for work done (or materials furnished, as the case may be,) in and about the construction (or removal, etc.,) of a (describe structure, whether dwelling, store, or etc.,) which he has contracted to construct (or remove, etc.,) for you or on property owned by you in the county (or city) of, and that I have duly recorded a mechanic’s lien for the same. Given under my hand this the day of, 20. (Subcontractor).
