Alaska Statutes Title 34. Property § 34.35.465. Form of notice

The form of notice required by AS 34.35.450-34.35.480 shall be substantially as follows:

NOTICE is hereby given that __________ has rendered services for hospitalization, physician services, or special nurses' services for __________, a person who was injured on the ___ day of __________ at __________ in the state, and the __________ (claimant) hereby claims a lien upon any money due or owing or any claim for compensation, damages, contribution, settlement, or judgment from __________ alleged to have caused the injuries and any other person liable for the injury or obligated to compensate the injured person on account of the injuries; the hospitalization, physician services, or special nurses' services were rendered to the injured person between the ___ day of __________ and __________:

and that 90 days have not elapsed since that time; that the claimant's demands for care and service is in the sum of $___ and that no part of the demands has been paid, except $___, and that there is now due and owing and remaining unpaid thereof, after deducting all credits and offsets, the sum of $___, in which amount lien is hereby claimed.

I, __________, being first duly sworn on oath say: That I am __________ named in the foregoing claim of lien; that I have read the same and know the contents thereof and believe the same to be true.

Subscribed and sworn to before me this ___ day of __________, 2___.