                                 CODE OF VIRGINIA

SUFFICIENCY OF MEMORANDUM AND AFFIDAVIT REQUIRED BY § 43-4 (§ 43-5)

The memorandum and affidavit required by § 43-4 shall be sufficient if
substantially in form and effect as follows:		Memorandum for Mechanic&#8217;s
Lien Claimed by General Contractor.		Name of owner:
___________________________________________________________________________		Add
ress of owner:
___________________________________________________________________________		Nam
e of claimant:
___________________________________________________________________________		Add
ress of claimant:
___________________________________________________________________________		Con
tractor license or certificate number of claimant		(if applicable):
___________________________________________________________________________		Iss
uance date of license or certificate		(if applicable):
___________________________________________________________________________		Exp
iration date of license or certificate		(if applicable):
___________________________________________________________________________		If
no contractor license or certificate number is included, the claimant certifies
that such a valid license or certificate is not  required by law for the work
done for which the benefit of a lien is claimed.

1. Type of materials or services furnished:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
			___________________________________________________________________________		
	___________________________________________________________________________

2. Amount claimed:  $
___________________________________________________________________________
			If any part of the Amount claimed is not due as of the date of this
mechanic&#8217;s lien, identify the date or event upon which it will be due and
the sum(s) to which the due date(s) or event(s) apply:
___________________________________________________________________________

3. Type of structure on which work done or materials furnished:
___________________________________________________________________________
			___________________________________________________________________________

4. Brief description and location of real property:
			___________________________________________________________________________

5. Date from which interest on the above amount is claimed:
			Date: _______________________			It is the intent of the claimant to claim the
benefit of a lien.			The undersigned hereby certifies that he has mailed a copy
of this memorandum of lien to the owner of the property at the owner&#8217;s
last known address:
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
(address), on &#8230;&#8230;..   (date of
mailing).			____________________________________________________________________
_______  (Name of claimant).			Affidavit.			State of Virginia,			County (or
city) of &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;,  to wit:			I,
_______________________  (notary or other officer) for the county (or city)
aforesaid, do certify that &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;. 
claimant, or &#8230;&#8230;&#8230;&#8230;&#8230;., agent for claimant, this day
made oath before me in my county (or city) aforesaid that
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; (the owner) is justly indebted
to claimant in the sum of &#8230;&#8230;&#8230;&#8230;.. dollars, for the
consideration stated in the foregoing memorandum, and that the same is payable
as therein stated.			Given under my hand this the &#8230;&#8230;.. day of
&#8230;&#8230;&#8230;&#8230;&#8230;..,
20&#8230;.			___________________________________________________________________
________ (Notary Public or Magistrate, et cetera.)

HISTORY: Code 1919, § 6427; 1940, p. 402; 1968, c. 568; 2007, c. 504; 2013, c.
293; 2019, c. 243.