These forms are for use by those who are working on Residential projects.
Please be mindful of the difference between an original contractor and a
sub-contractor (also known as a derivative claimant) and follow the form where
it indicates how to complete the form if you are a sub-contractor (a/k/a a
derivative claimant).
Beginning of Form
NOTICE: THIS IS NOT A LIEN.
THIS IS ONLY AN AFFIDAVIT CLAIMING A LIEN.
STATE OF TEXAS
COUNTY OF [NAME OF COUNTY]
MECHANIC'S AND MATERIALMAN'S LIEN AFFIDAVIT
Before me, the undersigned authority, a Notary Public in and for the state of
Texas, on this day personally appeared [PERSON MAKING AFFIDAVIT], who being by
me here and now duly sworn, upon oath says:
1. "My name is [PERSON MAKING AFFIDAVIT]. I am [TITLE OF PERSON MAKING
AFFIDAVIT] of [COMPANY PERSON MAKING AFFIDAVIT WORKS FOR], hereinafter referred
to as 'Claimant', and I am duly qualified and authorized to make this affidavit
and am personally cognizant of the facts stated herein and that such facts are
true and correct.
2. "Claimant has furnished labor and/or materials to improve the property
herein described.
3. " [OWNER OF PROPERTY] is the owner or reputed owner of the land herein
described and improvements located thereon. The last known address of such owner
is [ADDRESS OF OWNER]. [OWNER OF PROPERTY] also has an office at [2ND ADDRESS,
IF ANY, OF OWNER].
4. "The materials and/or labor were furnished by the claimant for the
improvement of real property in [NAME COUNTY] County, which real property is
described as follows:
[LEGAL DESCRIPTION OF PROPERTY]
5. "Claimant is the original contractor for such improvement.
5a. [IF YOU ARE NOT THE ORIGINAL CONTRACTOR, YOUR PARAGRAPH 5 SHOULD APPEAR
AS FOLLOWS: Claimant is a derivitave claimant. The original contractor for such
improvement is [NAME OF ORIGINAL CONTRACTOR] and the address of such original
contractor is [ADDRESS OF ORIGINAL CONTRACTOR].
6. "The labor and/or material were furnished under a written contract which
is attached hereto and made a part hereof.
7. "The principal amount of the claim is $[DOLLAR AMOUNT OF CLAIM, E.G.
$120,082.30], plus interest, and said amount is just and correct and all just
and lawful offsets, payments and credits known to the Affiant have been allowed.
The materials and/or labor are described as follows:
[DESCRIBE WORK DONE, E.G. General Renovation of Stadium Inn.]
8. "The materials and/or labor were furnished through the month of
September 1999.
9. "The Claimant's physical address is [YOUR COMPANY'S PHYSICAL ADDRESS].
10. "Notices of claim were sent to the owner [ADD IF APPLICABLE: and to the
original contractor] by certified mail on [DATE NOTICES SENT].
11. "The purpose of this affidavit is to claim a mechanic's and
materialman's lien on the above described land and improvements."
Further, affiant sayeth naught.
_______________________
[PERSON MAKING AFFIDAVIT], Affiant
[TITLE OF PERSON MAKING AFFIDAVIT], [COMPANY NAME]
SUBSCRIBED and SWORN to BEFORE ME, on this the [DATE OF AFFIDAVIT] day of MONTH
OF AFFIDAVIT], [YEAR OF AFFIDAVIT], to certify which witness my hand and seal of
office.
______________________
Notary in and for the State of Texas
After recording, return to:
[YOUR NAME]
[ADDRESS]
End of Form
