SECTION 43-5. Sufficiency of memorandum and affidavit required by § 43-4  

The memorandum and affidavit required by § 43-4 shall be sufficient if substantially in form and effect as follows:

Memorandum for Mechanic's Lien Claimed by General Contractor.

Name of owner: ___________________________________________________________________________

Address of owner: ___________________________________________________________________________

Name of claimant: ___________________________________________________________________________

Address of claimant: ___________________________________________________________________________

Contractor license or certificate number of claimant

(if applicable): ___________________________________________________________________________

Issuance date of license or certificate

(if applicable): ___________________________________________________________________________

Expiration date of license or certificate

(if applicable): ___________________________________________________________________________

If no contractor license or certificate number is included, the claimant certifies that such a valid license or certificate is not required by law for the work done for which the benefit of a lien is claimed.

1. Type of materials or services furnished: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________