lien & privilege certificate request · lien & privilege certificate request please note:...

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Revised 8/13/2018 LIEN & PRIVILEGE CERTIFICATE REQUEST Please Note: The Lien period will not start until an acceptance has been recorded in the Mortgage records. TO: ST. TAMMANY PARISH CLERK OF COURT AND EX-OFFICIO RECORDER OF MORTGAGES I HEREBY REQUEST A LIEN AND PRIVILEGE CERTIFICATE AS FOLLOWS: NAME OF OWNER(S): __________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ NAME OF CONTRACTOR(S): _____________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ PROJECT OR PROPERTY DESCRIPTION: ____________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ______________________________ AGREEMENT OR CONTRACT INSTRUMENT # ACCEPTANCE OR SUBSTANTIAL COMPLETION INSTRUMENT # ______________________________ To cover the cost of the above requested certificate, attached in the amount of $________________ is my Cash Check Bill my Account #________________ Credit Card (will incur a 3% convenience fee) Date: _______________ Signature: _________________________________ Printed Name:______________________________ Company Name: ____________________________ Title:_____________________________________ Mailing Address: ______________________________________________________________________ City: ______________________________________ State: ________________ ZIP: ________________ Telephone #: _______________________________ Email: ____________________________________

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Page 1: LIEN & PRIVILEGE CERTIFICATE REQUEST · LIEN & PRIVILEGE CERTIFICATE REQUEST Please Note: The Lien period will not start until an acceptance has been recorded in the Mortgage records

Revised 8/13/2018

LIEN & PRIVILEGE CERTIFICATE REQUEST

Please Note: The Lien period will not start until an acceptance has been recorded in the Mortgage records.

TO: ST. TAMMANY PARISH CLERK OF COURT AND EX-OFFICIO RECORDER OF MORTGAGES

I HEREBY REQUEST A LIEN AND PRIVILEGE CERTIFICATE AS FOLLOWS:

NAME OF OWNER(S): __________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

NAME OF CONTRACTOR(S): _____________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

PROJECT OR PROPERTY DESCRIPTION: ____________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

______________________________ AGREEMENT OR CONTRACT INSTRUMENT #

ACCEPTANCE OR SUBSTANTIAL COMPLETION INSTRUMENT # ______________________________

To cover the cost of the above requested certificate, attached in the amount of $________________

is my Cash Check Bill my Account #________________ Credit Card (will incur a 3% convenience fee)

Date: _______________

Signature: _________________________________ Printed Name:______________________________

Company Name: ____________________________ Title:_____________________________________

Mailing Address: ______________________________________________________________________

City: ______________________________________ State: ________________ ZIP: ________________

Telephone #: _______________________________ Email: ____________________________________