2015 Code of Virginia
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 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: $__________

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.