HomeMy WebLinkAbout99-03158MECHANICS' LIEN LAW OF 1563, P. L. 497 49 P. S. 1101.1902
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IN THE COURT OF COMMON PLEAS OF
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.......................
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CLAIMANT
vs
&rfib1,,Zand COUNTY, PENNSYLVANIA
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OWNER(S) or REPUTED OWNER(S)
01-7. e6,V
a?'fU/ /VOG'7}/??Mds N,e.,5bu d./A1?1/p plaintiff, claimant above named,
hereby, files claim or statement of demand for the price and value of materials furnished
and for work and labor done for and about the erection and construction of a certain improvement,
building or structure hereinafter described, against the said improvement, building or structure and
the ground thereby covered, and so much other ground immediately adjacent thereto and belonging
to the owner(s) or reputed owner(s) thereof, as may be necessary for the ordinary and usual
purposes of such building, and set forth in claim as follows:
1. The name of the claimant contractor/subcontractor and business address:
u1i
2. The name(s) of the owner(s) or reputed owner(s) of the improvement, building, or struc-
ture and property and
address(es):
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3. The date of completion of claimant's work: 191
4. If a subcontractor claimant-
(a) the names of the part with who
the claimant contracted:
(b) The date preliminary notice was given to the owner(s) o eputed owner (s) of intention to
file a claim: (Required only in cases covered in Section 1501 (a)).
3/3//99
(c) The date of formal notice to the owner(s) or reputed owner(s) of intention to file a claim:
3/3/ /97n
5. If a contractor claimant filing under a contract or contracts for an agreed sum-
(a) an identification of the contract or contracts:
(b) a general statement of the kind and character of the labor and/or materiels furnished:
L <--•5 ?A)CLJS?U
'401,91 ,
6. In all other cases than those covered in item S. insert here a detailed statement of the kind
and character of the labor and/or materials furnished and the prices charged for each thereof: (At-
tach additional sheets if necessary)
7. The amount or sum claimed to be due is in excess of the statutory minimum of $500.00
dollars, being in fact $ /dUU.UO dollars, with intereet from /n/1, ,411 ;'?,q , 19 V`7
for work done and completed and materials furnished within four (4) months last past for and about
the erection and construction and upon the credit of the improvement, building or structure here-
inafter described.
8. The lien is claimed against the following described property, and the improvement, building
or structure erected thereon, to-wit: (Describe. both in sufficient detail to reasonably identify them.)
WITNESS the hand of said claimant contractor/subcontractor this day of
19 qq.
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