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Zisholtz
200 Garden City Plaza Garden City, NY 11530
info@zzllp.com
516-741-2200
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info@zzllp.com
516-741-2200
Linkedin
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Practice Areas
Construction Law
Commercial Litigation
Real Estate
Legal Insights
Contact
Menu
Home
Our Firm
Our Team
Practice Areas
Construction Law
Commercial Litigation
Real Estate
Legal Insights
Contact
File A Lien
File a Lien
Lien Form
Name of your company:
*
Address
*
City
State/Province
ZIP / Postal Code
Telephone Number:
*
Fax Number:
Officer Signed Lien:
*
Officer Signed Lien:
*
Title
Title1
Title2
Material sold or labor performed (be specific please):
*
A. Original Contract Amount
*
USD
B. Change Orders
*
USD
Total Contract Including Change Orders (A + B)
C. Amount Paid
USD
D. Credits
USD
Did you manufacture material for this project and not deliver it?
Select Yes/No
Yes
No
If yes, set forth what material was manufactured and not delivered.
E. Set forth the value of the material:
USD
F. Amount to be liened: (A+B+E-C-D):
The time when the first item of work was performed and the materials was furnished was:
The time when the last item of work was performed and the materials was furnished was:
Address
City
State/Province
ZIP / Postal Code
The name of the customer or contractor to whom the lienor furnished or is it furnish materials or for whom the lienor performed or is to perform professional services is :
Address
City
State/Province
ZIP / Postal Code
Is customer the general contractor?
Select Yes/No
Yes
No
Address
City
State/Province
ZIP / Postal Code
The owner of the real property is (if known):
Is this a public improvement job?
Select Yes/No
Yes
No
Please provide the contact number:
Send Form
