Virginia Code Title 43. Mechanics' and Certain Other Liens § 43-8. Sufficiency of memorandum, affidavit and notice required by § 43-7

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'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).

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 .......... day of ..............., 20......

........................................ (Notary Public or Magistrate, et cetera.)

To ........................................ (owner).

You are hereby notified that .................... (general contractor) is indebted to me in the sum of ............... dollars ($..........) with interest thereon from the .......... day of ..............., 20....., for work done (or materials furnished, as the case may be,) in and about the construction (or removal, etc.,) of a .................... (describe structure, whether dwelling, store, or etc.,) which he has contracted to construct (or remove, etc.,) for you or on property owned by you in the county (or city) of ...................., and that I have duly recorded a mechanic's lien for the same.

Given under my hand this the .......... day of ..............., 20......

........................................ (Subcontractor).