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Hellmuth & Johnson PLLC

8050 West 78th Street, Minneapolis, MN 55439
LOCAL 952-941-4005
FREE 888-343-3918
FAX 952-941-2337
info@hjlawfirm.com

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Community Association
Construction
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Real Estate
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MECHANIC'S LIEN INTAKE FORM

1. Lien Claimant (your name):
2. Your Address:
3. Your Phone:
4. Street Address of Project:
5. Legal Description of Project (if known. If not known, we will obtain it):
6. Dollar amount of claim*:

*Do not include any amount for Work that has not been performed yet, unless you have a written contract for specified price. List any interest or finance charges separately. Intentional overstatement of the lien will result in loss of the entire lien, and possible monetary sanctions.
7. First date of Work (includes delivery of equipment and materials):
8. Last date of Work (does not include warranty work):
9. Current Property Owner(s) (if known):
10. Current Property Owner(s) address (if known):
11. Name of entity or person that hired or directed you to do the Work:
Address:
Telephone:
12. Brief description of Work/Improvements provided to the Property:
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