Free Sample New York Private Mechanic’s Lien: Notice and Filing Checklist

Reviewed September 7, 2026.

This readable sample replaces the older image-only form and instructions. It illustrates the information required by Lien Law § 9 for a private improvement. It must be adapted to the claimant, project and county; it is not a public-improvement lien form or a determination that you have lien rights.

Sample notice outline

NOTICE UNDER NEW YORK LIEN LAW—PRIVATE IMPROVEMENT
To the Clerk of [county], New York:

[Exact legal name of lienor] claims a lien against the property and owner’s interest identified below for the unpaid amount stated in this notice.

1. Lienor: [Name and residence; for an entity, business address, principal place of business and other applicable information required by § 9(1), including partners’ names or a foreign corporation’s New York principal place of business as applicable.]
2. Attorney, if any: [Name and address. Do not name an attorney who has not been retained.]
3. Owner and interest: [Record owner’s correct legal name and the interest against which the lien is claimed, as far as known. Do not automatically assume fee ownership.]
4. Contracting or employing party: [Name of the person or entity that employed the lienor, contracted with the lienor, or received or was to receive the materials, as applicable.]
5. Labor and materials: [Accurate description of the work performed or materials furnished and their agreed price or value. Separately identify any qualifying materials actually manufactured for but not delivered to the property.]
6. Amount unpaid: [$ amount owed for the lienable labor or materials, after appropriate payments and credits. Reconcile this figure with the project records.]
7. Dates: [Dates of the first and last qualifying work and materials, stated accurately for the claim.]
8. Property: [Description sufficient to identify the property; street and number if known; county and appropriate block, lot or parcel details. Attach an adequate legal description if needed.]
9. Single-family status: [State whether the property is improved or to be improved with a single-family dwelling. Evaluate the actual facts and statutory exceptions.]

Dated: [date]
Lienor: [name]
By: [signature and capacity]

Verification

The lienor or authorized agent must verify the notice as § 9 requires. The verification should identify the person and capacity, confirm the truth of matters within personal knowledge and the person’s belief in matters expressly stated on information and belief, and explain an agent’s authority where appropriate. Use a proper sworn verification and jurat with the required notarial information. A signature acknowledgment alone should not be substituted without checking the verification requirement.

Filing and service checklist

• Confirm eligibility, licensing where applicable, the owner and property interest, lienable charges and the available lien fund.
• Under § 10, the usual private filing period is eight months, with a four-month single-family rule and a separate retainage rule. Investigate classification, exceptions and the actual deadline before using the form.
• File with the clerk for the county where the property is situated and confirm current fees and submission requirements.
• Arrange proper owner service under § 11 and any contracting-party service under § 11-b. The private-lien service window is five days before through 30 days after filing. Recipients and permitted methods depend on the applicable provision.
• File the required proof of service within 35 days after filing the notice. The old image instructions incorrectly used 30 days for this proof-filing deadline. A service affidavit must accurately record what the server actually did, including recipients, addresses, method and dates; preserve the corresponding mailing or delivery records.
• Calendar expiration, extensions, foreclosure and any statutory demand separately. Filing alone does not collect the debt.

Do not fill unknown facts with guesses or sign a false verification. Have the notice and service plan reviewed before filing.

Kushnick Pallaci PLLC assists clients throughout New York with New York mechanic’s lien preparation and review. Contact 631-752-7100 or vtp@kushnicklaw.com.

Attorney Advertising. General information, not legal advice.