TO: (name of owner)
(address)

Notice is hereby given that the undersigned, (name)
intends to file a mechanic’s lien for (amount) Dollars
($ ), on real property owned by you and commonly known
as (street address) . The legal for said property
is as follows:

The filing of said lien, pursuant to (cite statute) , is
for the purpose of securing payment of amounts due for
(services) performed by the undersigned within the last
(number) days, in accordance with the (written or oral)
agreement entered into on (date) between you and the
undersigned.

Date________________ __________________________
(Signature)