2017 Code of Virginia
Title 43 - Mechanics' and Certain Other Liens
Chapter 1 - Mechanics' and Materialmen's 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.