TO THE CLERK, COUNTY OF __________:
NOTICE OF UNPAID BALANCE AND RIGHT TO FILE LIEN
In accordance with the "Construction Lien Law," P.L. 1993, c.318 (C.2A:44A-1 et al.), notice is hereby given that:
TOTAL LIEN CLAIM AMOUNT E - [F + G] = $______________
CLAIMANT'S REPRESENTATION AND VERIFICATION
Claimant represents and verifies that:
Name of Claimant____________________________
Signed______________________________________
(Type or Print Name and Title)
SUGGESTED NOTARIAL FOR INDIVIDUAL CLAIMANT:
STATE OF NEW JERSEY
COUNTY OF [ ] ss:
On this ____ day of ______ 20___, before me, the subscriber, personally appeared (person signing on behalf of claimant(s)) who, I am satisfied, is/are the person(s) named in and who executed the within instrument, and thereupon acknowledged that claimant(s) signed, sealed and delivered the same as claimant's (s') act and deed, for the purposes therein expressed.
________________________
NOTARY PUBLIC
SUGGESTED NOTARIAL FOR CORPORATE OR LIMITED LIABILITY CLAIMANT:
STATE OF NEW JERSEY
COUNTY OF [ ] ss:
On this ____ day of ______ 20__, before me, the subscriber, personally appeared (person signing on behalf of claimant(s)) who, I am satisfied is the Secretary (or other officer/manager/agent) of the Corporation (partnership or limited liability company) named herein and who by me duly sworn/affirmed, asserted authority to act on behalf of the Corporation (partnership or limited liability company) and who, by virtue of its Bylaws, or Resolution of its Board of Directors (or partnership or operating agreement) executed the within instrument on its behalf, and thereupon acknowledged that claimant signed, sealed and delivered same as claimant's act and deed, for the purposes herein expressed.
_________________________
NOTARY PUBLIC
N.J.S. § 2A:44A-20