STATE OF TEXAS §
COUNTY OF HARRIS §
BEFORE ME, the undersigned authority, this day personally appeared _______, the undersigned Affiant, known to me, who, being first duly sworn, deposed and testified upon her oath as follows:
- My name is _____. I am the accounts manager of XYZ, Inc. hereinafter referred to as “XYZ” or “Claimant.” XYZ’s business address is: __________. I have personal knowledge of the facts set forth herein and I am competent and authorized to make this affidavit on behalf of XYZ. The facts contained herein are true and correct.
- This Affidavit is made on behalf of XYZ to perfect the Mechanic’s and Materialman’s Lien against the real property described below.
- Claimant has an unpaid claim in the amount of $____ for labor and materials furnished on the construction of improvements generally known as the ABC construction project. The claimed amount of $_____ is, within my personal knowledge, just and true, the same is due and unpaid, and all just and lawful offsets, payments and credits have been allowed. The $_____ indebtedness is a result of the non-payment of due invoices and this amount is reflected in the summary of due invoices for this project, a true and correct copy of which is attached hereto as Exhibit “A.” The claim amount is for labor and materials furnished and described below, on which a systematic record has been kept.
- The name and last known address of the owner or reputed owner of the real property and improvements upon which this claim is made is: Owner, Inc. The property address is _______. The legal description of the property is _____.
- The claim amount of $______ represents the unpaid contract price due Claimant, or in the alternative, is the reasonable value of the unpaid portion of Claimant’s labor and materials furnished, which are described below.
- Claimant’s labor and materials furnished for construction of improvements on the real property described herein are generally described as labor and materials for ____________. The labor and materials are more particularly described on the summary of invoices for this project attached hereto as Exhibit “A.”
- A breakdown of the dollar amount of the labor and materials provided by month for the project by Claimant and for which Claimant has not received payment is as follows: December 2004 $ ______; January 2004 $_______; and February 2004 $_______.
- Claimant furnished the above-described labor and materials under a contract with GC, Inc. whose last known address is _____. GC, Inc. is the original contractor for the improvements for which the lien is claimed.
- The legal description of the real property improved by Claimant’s above-described labor and materials, and which real property and improvements thereon are sought to be charged with Claimant’s lien, is ___________.
- Claimant claims a Mechanic’s and Materialman’s lien upon the above-described real property and improvements thereon to secure payment of its claim in the amount of $_______ in accordance with the Texas Property Code.
- Claimant sent notices to GC, Inc. about the unpaid invoice amounts on January 15, 2004, February 15, 2004 and March 15, 2004. These notices were sent by certified mail, return receipt requested.
- Claimant sent a notice to Owner, Inc. about the unpaid invoice amounts on February 15, 2004 and March 15, 2004. These notices were sent by certified mail, return receipt requested.
- In compliance with the Texas Property Code, Claimant is sending one copy of this Affidavit to the above-referenced Owner, at its last known address, and also one copy to the above-referenced original contractor at its last known address.
Further affiant sayeth not.
STATE OF TEXAS §
COUNTY OF HARRIS §
Before me, the undersigned authority, on this day personally appeared ________, known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that she executed it for the purposes therein expressed, and in the capacity therein stated as the act and deed of such business.
SUBSCRIBED AND SWORN TO before me, the undersigned authority, on this the ______ day of _______, 2004, to certify which witness my hand and seal of office.
Notary Public in and for the State of Texas