Indiana Mechanics Lien Template

Information you will need

• Recipient Name
• Recipient Address
• Date of Service
• Time of Service (Hour)
• Time of Service (Minute)
• Other Mail Type
• Recipient at Residence/Workspace
• Area left at Residence/Workspace
• Other Service Method
• Server Signing Date
• Server Name
• Method of Delivery
• Mail Type / Carrier
• Time (AM or PM)
• Work Start Date
• Work End Date
• Payment Received (so far)
• Claimant Signing Date
• Claimant Printed Name
• Payment Received
• Notary State
• Notary County
• Signing Date (Notarization)
• Claimant Name (Notarization)

…and 16 more fields in the PDF.

Completed by the recipient.

The form includes 2 signature lines, a notary acknowledgment.