When Recorded Return to:. . ..
CLAIM OF WAGE LIEN
. . . . ., claimant, vs. . . . . ., name of person indebted to claimant:
Notice is hereby given that the claimant named below asserts a wage lien pursuant to chapter 60.90 RCW. In support of this wage lien the following information is submitted:
TELEPHONE NUMBER:. . ..
ADDRESS:. . ..
. . ..
. . ..
. . ..
. . ..
. . ..
. . ..
. . ..
NAME:. . ..
REPRESENTATIVE CAPACITY (e.g., officer or employee of claimant; attorney or agent; representative of lien filing service; administrator, representative, or agent of trustees of employee benefit plan):. . ..
. . ..
ACKNOWLEDGMENT
FOR AN ACKNOWLEDGMENT IN AN INDIVIDUAL CAPACITY:
STATE OF WASHINGTON, COUNTY OF
. . . . . ., ss.
. . . . . ., being sworn, says: I, . . . . .(name of person). . . . ., am the claimant. I have read the foregoing claim of wage lien, believe the claim of wage lien to be true and correct under penalty of perjury, and believe the claim of wage lien is not frivolous, is made with reasonable cause, and is not clearly excessive. The foregoing claim of wage lien is my free and voluntary act for the uses and purposes stated therein.
. . . . . .Dated:. . ..
. . ..
. . ..
. . ..
(Signature)
FOR AN ACKNOWLEDGMENT IN A REPRESENTATIVE CAPACITY:
STATE OF WASHINGTON, COUNTY OF
. . . . . ., ss.
. . . . . ., being sworn, says: I, . . .(name of person). . ., am authorized to act on behalf of the claimant. I have read the foregoing claim of wage lien, believe the claim of wage lien to be true and correct under penalty of perjury, and believe the claim of wage lien is not frivolous, is made with reasonable cause, and is not clearly excessive. The foregoing claim of wage lien is the free and voluntary act of the claimant for the uses and purposes stated therein.
. . . . . .Dated:. . ..
. . ..
. . ..
. . ..
(Signature)
CERTIFICATE
FOR A CERTIFICATE OF ACKNOWLEDGMENT IN AN INDIVIDUAL CAPACITY:
I certify that I know or have satisfactory evidence that . . . (name of person) . . . is the person who appeared before me, and said person acknowledged that he/she signed this instrument and acknowledged it to be his/her free and voluntary act for the uses and purposes mentioned in the instrument.
. . . . . .Dated:. . ..
. . ..
. . ..
. . ..
(Signature)
(Seal or stamp)
. . . . . . . Title. . ..
. . . . . . . My appointment. . ..
. . . . . . . Expires. . ..
FOR A CERTIFICATE OF ACKNOWLEDGMENT IN A REPRESENTATIVE CAPACITY:
I certify that I know or have satisfactory evidence that . . . (name of person) . . . is the person who appeared before me, and said person acknowledged that he/she signed this instrument, on oath stated that he/she was authorized to execute the instrument and acknowledged it as the . . . (type of authority, e.g., officer or employee, etc.) . . . of . . . (name of party on behalf of whom instrument was executed) . . . to be the free and voluntary act of such party for the uses and purposes mentioned in the instrument.
. . . . . .Dated:. . ..
. . ..
. . ..
(Signature)
(Seal or Stamp)
. . . . . . Title. . ..
. . . . . . My appointment. . ..
. . . . . . Expires. . ..
RCW 60.90.030