To: __________________________ (owner)
__________________________ (address)

__________________________

__________________________

Notice is given that the undersigned, ______________________________________, of ________________________________________________________________ (address) claims a lien on property held by the undersigned belonging to you for services rendered, as follows:

1. The property held is described as ______________________________________.

2. The lien is claimed for the following services rendered: _______________________.

3. The amount of charges due is ($__________).

4. The charges have remained unpaid for _______________ days.

Unless payment in full is made within __________ days, the undersigned will sell the property at __________________________ (public or private) sale, and apply the proceeds to the amount due.

_________________________ _____________________

Signature Date

_________________________ _____________________

Signature Date