goLCA.com Home Page
goLCA.com Home Page
"LCA Online" Demo
Click here for Claim of Lien Request Form
Credit Check
Request an Account
About LCA
Contact Us
Y2K Statement
Member Login
Request to Fill Out & Record Claim of Lien

Please prepare a Claim of Lien in accordance with the following information, which you may rely on at your normal applicable fees. WE hereby appoint and authorize Van Saliba, President of LCA to be our Agent for the Claim of Lien herein. WE HEREBY CERTIFY the described materials were used, or labor and services performed, in the improvement of the real property named below; that no waiver or release of lien rights have been executed for the sums claimed; that all the information stated below is true and correct; that a proper license is held for the work claimed by the Lienor; and that if I am not dealing directly with the owner, the owner with the contractor agreement is more than $2500.00

Lumbermen’s (hereinafter referred to as LCA) will prepare the claim of Lien from the information furnished by the undersigned.

LCA does not provide legal advice, as LCA is not a law firm. Should you desire legal advice, we can refer you to legal counsel.

In the event of any claim by the undersigned for damages of any kind, loss of funds, attorney fees, court costs, breach of agreement, negligence or breach of duty, the undersigned and/or Company agrees that the absolute limit of liability of LCA for any claims arising out of, connected with, or related to their services in preparing and/or recording the lien requested herein is limited to the sums paid to LCA preparing and recording this lien.

Date of FIRST furnishing of labor/materials to jobsite:
Date of LAST furnishing of labor/materials to jobsite:
Our direct customer is :
Labor and/or Materials Furnished :
Total Value of what we furnished:
$
Balance owing for what we furnished:
$
Job Address of Property to Lien :
Send Lumbermen’s a Copy of YOUR Notice to Owner. If no Notice to Owner, provide Legal Description of property, as Lumbermen’s will research and there is an additional $39 research charge.
   
Your Firms Name
Account Number
Phone Number

Fax Number
Address

City

State

Zip Code

Name of Signer and Title
Country

 
  back to top