2014 Virginia Code
Title 43 - Mechanics' and Certain Other Liens
§ 43-5. Sufficiency of memorandum and affidavit required by § 43-4
The memorandum and affidavit required by § 43-4 shall be sufficient if substantially in form and effect as follows:
Memorandum for Mechanic's Lien Claimed by General Contractor.
Name of owner:.........................................................…
Address of owner:......................................................…
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 notrequired 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:$...............................................…
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 the above amount is claimed:
Date: ...................…
It is the intent of the claimant to claim the benefit of a lien.
The undersigned hereby certifies that he has mailed a copy of this
memorandum of lien to the owner of the property at the owner's last known
address: ..................................(address), on ....…(date of
mailing).
.......................................................… (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 .................… (the owner) 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.)
Code 1919, § 6427; 1940, p. 402; 1968, c. 568; 2007, c. 504; 2013, c. 293.
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