(Consult an attorney before using this form or relying on this information)
REQUEST FOR SWORN STATEMENT OF ACCOUNT
WARNING: YOUR FAILURE TO FURNISH THE REQUESTED STATEMENT WITHIN 30 DAYS OR THE FURNISHING OF A FALSE STATEMENT WILL RESULT IN THE LOSS OF YOUR RIGHT TO RECOVER ATTORNEY FEES IN ANY ACTION TO ENFORCE THE CLAIM OF LIEN OF THE PERSON REQUESTING THIS STATEMENT.
To: (Owner’s name and address)
The undersigned hereby demands a written statement under oath of his or her account showing the amount of the direct contract under which the lien was recorded, the dates and amounts paid or to be paid by or on behalf of the owner for all improvements described in the direct contract, the reasonable estimated costs of completing the direct contract under which the lien was claimed pursuant to the scope of the direct contract, and if known, the actual cost of completion. as of the date of the statement for the improvement of real property identified as (property description).
The undersigned’s contract is with (contracting party) and the prime contractor is (prime contractor).
(signature and address of lienor)
(date of request for sworn statement of account)