20-Day Preliminary Lien Notice Form

20-Day Preliminary Lien Notice Form (Arizona)

Property Owner Name

Jobsite Address Property Where Work Was Performed

Parcel Number (if known)

County

Your Full Legal Name Business Name

Mailing Address

Phone Number

Email Address

example@example.com

Name of Person or Company Who Hired You

Hiring Party Address

Type of Work or Materials Provided

Date Work First Provided

Date

Estimated Value of Work/Materials to date

Amount ($)

Subcontractor or Additional Parties

Name of General Contractor if known

Name of Construction Lender if any

Other Interested Parties optional

I certify that the information provided above is true and correct to the best of my knowledge and that this notice is being served in accordance with A.R.S. § 33-992.01.

Authorized Party

Printed Name and Title

Signature

20-Day Preliminary Lien Notice Form (Arizona)

Documents Needed for the Preliminary Lien

Upload File