                                 CODE OF VIRGINIA

SUFFICIENCY OF MEMORANDUM, AFFIDAVIT AND NOTICE REQUIRED BY § 43-9 (§ 43-10)

The memorandum, affidavit and notice required by § 43-9 shall be sufficient if
substantially in form and effect as follows:
		Memorandum for Mechanic&#8217;s Lien Claimed by Sub-subcontractor.
		Name of owner:
___________________________________________________________________________
		Address of owner:
___________________________________________________________________________
		Name of general contractor (if any) and subcontractor:
		___________________________________________________________________________
		Name of claimant: 
___________________________________________________________________________
		Address of claimant: 
___________________________________________________________________________
		Contractor license or certificate number of claimant
		(if applicable):
___________________________________________________________________________
		Issuance date of license or certificate
		(if applicable):
___________________________________________________________________________
		Expiration 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 above amount is claimed:
			Date: ____________________________
			It is the intent of the claimant to claim the benefit of a lien.
			____________________________  (Name of claimant).
			______________ (Signature of claimant or agent for claimant).
			Affidavit.
			State of Virginia,
			County (or city) of ________________________, to wit:
			I,
___________________________________________________________________________
(notary or other officer) for the county (or city)
			aforesaid do certify that ___________________________________________
claimant, or ___________________________________________, agent for claimant,
this day made oath before me in my county (or city) aforesaid that
_______________ is justly indebted to claimant in the sum of __________ 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;&#8230;&#8230;&#8230;. day of
&#8230;&#8230;&#8230;&#8230;&#8230;, 20&#8230;.
			________________________________________ (Notary Public or
			Magistrate, et cetera.)
			Notice.
			To __________________________ (owner) and __________________________ (general
contractor):
			You are hereby notified that
___________________________________________________________________________ , a
subcontractor under you,
			said
___________________________________________________________________________
(general contractor) for the construction (or removal,
			etc.,) of a
___________________________________________________________________________ 
(describe structure) for you, or on property owned by
			you, said
___________________________________________________________________________ 
(owner) is indebted to me in the sum of &#8230;&#8230;&#8230;&#8230;.
			&#8230;&#8230;&#8230;&#8230;&#8230;.. dollars ($ ______________) with
interest thereon from the &#8230;. day of &#8230;&#8230;., 20&#8230;, for work
done (or materials furnished) in and about the construction (or removal, etc.,)
of _________________________  (naming structure), situate in the county (or
city) of _______________ Virginia, and that I have duly recorded a
mechanic&#8217;s lien for the same.
			Given under my hand this the &#8230;&#8230;&#8230;&#8230;&#8230;&#8230; day
of &#8230;&#8230;&#8230;&#8230;&#8230;, 20&#8230;&#8230;.
			__________________________________________________ (Sub-subcontractor).

HISTORY: Code 1919, § 6429; 1968, c. 568; 1984, c. 647; 2007, c. 504; 2013, c.
293; 2019, c. 243.