Section 5.49 By Original Contractor

• Library: Creditors' Remedies 2014 Forms

In the Circuit Court of ________________ County

Statement of Mechanic’s Lien

[by Original Contractor]

[Lien Claimant] _______________, a ______________ corporation (hereinafter “lien claimant”), with its principal place of business located at ________________ and with a view toward availing itself of the statutes relating to mechanic’s liens, files the account set out on the attached Exhibit A, made a part hereof for all purposes, for work and labor performed and materials furnished by it under contract with ________________, the owner, for real estate located at [address] ________________, in ________________ County, Missouri. A true and correct legal description of the property (hereinafter “subject real estate”) is:

[lengthy descriptions may be attached

by separately identified exhibit]

The fee simple title to the above premises and to the improvements thereon is presently held by ________________. The fee simple title to the above premises was held by ________________ on the dates that lien claimant’s work, labor, materials, fixtures, and machinery were contracted for and provided or furnished for the subject real estate.

The account described on the attached Exhibit A is being filed herewith so that it may constitute a lien on the subject real estate. The last date work and labor were performed on the subject real estate by the lien claimant was the _____ day of ________________, 20___.

Labor performed and materials supplied as per statement of account attached to and incorporated in this statement by reference as Exhibit A and statement of materials and labor attached to and incorporated in this statement by reference as

Exhibit B........................................................................................................ $ ________________

Extra Work.................................................................................................... $ ________________

Less Payments Received............................................................................... $ ________________

Total Due....................................................................................................... $ ________________

[Lien Claimant]

By: ______________________________________

[Name of Signator and Title]

[Name of Lien Claimant]

State of __________________ )

) ss.

County of _________________ )

________________, of lawful age, being duly sworn upon his/her oath, states that the facts set forth in the preceding...