Oregon Revised Statutes Water Resources: Irrigation, Drainage, Flood Control, Reclamation § 547.510

Notice is given that _______, a drainage district organized under and pursuant to the provisions of ORS chapter 547, claims a lien upon that certain crop of _______ growing on the following described lands located in the drainage district in ________ County, Oregon: _______, for that portion of the annual charges or assessments levied by the above-named drainage district against lands, or owners or occupants of the lands, on which the crop is growing, for maintenance and operation of the district, in the sum of $_____; that the name of the owner or reputed owner of the crop is _______; that the owner of the land on which the crop is growing is _______; that no part of the charge or assessment for which a lien herein is claimed has been paid, except $_____; and that there now is due and remaining unpaid thereon, after deducting all just credits and offsets, the sum of $_____.

State of Oregon,

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ss.

County of ____________

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    I, ____________________, being first duly sworn, on oath say that I am _______ of the drainage district named in the foregoing claim, that I have personal knowledge of the facts therein set out; that I know the contents thereof, and believe the same to be true.

    Subscribed and sworn to before me this _____ day of _______, 2_____.

(Seal)

My commission expires ____________________.