Plantilla de Formulario de Reclamación de Gravamen

Claimant:

Name:: [Full Legal Name / Business Name]

Address:: [Claimant's Address]

Phone:: [Phone Number]

Email:: [Email Address]

Against Property Owned by:

Name:: [Owner's Full Legal Name]

Address:: [Owner's Address]

Property Description:

[Full Legal Description of Property, including address, lot, block, subdivision, county, and state]

1. Statement of Claim

The Claimant performed labor, furnished materials, or provided services for the improvement of the property described above under contract with [Name of Contractor/Subcontractor/Owner].

2. Amount Owed

The total amount due and unpaid for such labor, materials, or services is $[Amount]. This amount became due on [Date].

3. Nature of Work

The work performed or materials furnished included:

[Brief description of work or materials provided, e.g., roofing, plumbing, electrical supplies, construction materials]

4. Dates of Work

The work and/or furnishing of materials commenced on [Start Date] and was completed or last provided on [End Date].

5. Legal Right to Lien

The Claimant asserts a lien against the property pursuant to [cite relevant state statute or lien law], securing payment of the unpaid balance for the improvements described herein.