Private Form #6 – AFFIDAVIT CLAIMING LIEN
THE STATE OF TEXAS :
AFFIDAVIT CLAIMING LIEN
COUNTY OF (4) :
BEFORE ME, a notary public in and for the State of Texas, on this day personally appeared the undersigned,
who being by me duly sworn, on oath states:
1. My name is (1) . I am the (2) of (3) (“Claimant”) and am authorized
to make this affidavit on its behalf as the sworn statement of its claim.
2. Claimant furnished labor and/or materials for the improvement of the following described land in
(4) County, Texas:
3. The labor and/or material was furnished for such improvement to (6) . (7) .
4. (8) is the original contractor for such improvement.
5. (9) is the owner or reputed owner of the land and improvements thereon.
6. The kind of work done and/or material furnished by claimant is (10) and is made up of the
items shown on the attached Exhibit “A” which reflects the dates of Performance and/or delivery.
7. The amount unpaid for such furnishing and due and owing to claimant is $ (11) , which is true,
correct, and just, with all just and lawful offsets, payments, and credits known to affiant allowed.
8. Claimant’s address is (12) .
9. Claimant provided notices as required under Chapter 53 of the Texas Property Code on (13)
Claimant claims a lien against all the above described land and improvements thereon, including, without
limitation, removables, in the amount shown above pursuant to Chapter 53 of the Texas Property Code, [and/or the
Texas Constitution] and makes this sworn statement of claim in support thereof.
THE STATE OF TEXAS :
COUNTY OF ________ :
BEFORE ME, the undersigned authority, on this day personally appeared (1) , (2) of
(3) , known to me to be the person and officer whose name is subscribed to the foregoing instrument, who after
being by me duly sworn acknowledged that the statements contained above are true and correct and that he executed the
same for the purposes and consideration therein expressed, in the capacity therein stated, and as the act and deed of said
Given under my hand and seal of office this ____ day of _________, 20___.
Notary Public – State of Texas
Typed or Printed Name of Notary Public
My Commission Expires:
* * * * *
(1) Name of the person signing the affidavit.
(2) Position of the affiant with the claimant, such as credit manager, controller, owner, partner, president, etc.
(3) Name of claimant.
(4) County in which the land is located.
(5) Legal description of the land, e.g.:
(a) Lot 1, Block 2, Jones Subdivision of the City of Austin, per plat recorded in Volume ___, Page
_____, Plat Records, Travis County, Texas; or
(b) The 50 acres covered by the deed from Frederic N. Freeloader to Horace P. Homeowner, dated
________, recorded in Volume _____, Page _____, Deed Records, Travis County, Texas, which is
referred to for a more complete description.
(6) Name of the general contractor or subcontractor for whom work was done or material was furnished. If a
subcontractor, add “a subcontractor.”
(7) If the work or material was furnished under a written contract, it is preferable to attach the contract and
insert, “The labor and/or material was furnished under a written contract which is attached hereto and made
a part hereof.”
(8) Name of original (general) contractor.
(9) Name of property owner.
(10) General description of work done or materials supplied.
(11) Amount due, including retainage.
(12) Your business address.
(13) Dates of prior notices.
(14) e.g., partnership, corporation, etc.
Note: Original contractors (those contracting with the owner) also have a Texas Constitutional lien. If appropriate, you
may wish to claim such a lien.
Williams, McClure & Parmelee is dedicated to high quality legal representation of businesses and insurance companies in a variety of matters. We are experienced Texas civil litigation attorneys based in Fort Worth who know Texas courts and Texas law. For more information, please contact the law firm at 817-335-8800. The firm’s new office location is 5601 Bridge Street, Suite 300, Fort Worth, Texas 76112.