Property Description: Land and buildings located at _________________________________ in
______________________, Maine, being further described in the _______________________
County Registry of Deeds in Book __________, Page ____________.
I, _______________________________________________, designated broker of
_________________________________________, known as lien claimant, being first duly sworn, claims a lien on the above property for labor performed, said labor furnished with the full knowledge and consent of the owners of said property. The first date of furnishing labor was
___________________________ and the last date was ________________________________.
STATE OF MAINE
COUNTY OF ,ss. , 199
Personally appeared the above named _________________________________________
and made oath to the truth of the facts contained herein.