§ 43-5. Sufficiency of memorandum and affidavit required by { 43-4
The memorandum and affidavit required by § 43-4 shall be sufficient if substantially in form and effect as follows:
Memorandum for Mechanic's Lien Claimed by General Contractor.
Name of owner: ............
Address of owner: ............
Name of claimant: ............
Address of claimant: ............
1. Type of materials or services furnished: ............
............
............
2. Amount claimed: $ ............
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's last known
address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(address), on . . . . . . . . (date of mailing).
............ (Name of 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 . . . . . . . . . .
. . . . . . . . . . . (the owner) 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.)
(Code 1919, § 6427; 1940, p. 402; 1968, c. 568; 2007, c. 504.)
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