District of Columbia Notice of Mechanic's Lien

Notice of Mechanic's Lien
Form ROD 16
NOTICE OF MECHANIC’S LIEN
Government of the
District of Columbia
Office of Tax
and Revenue
Recorder of Deeds
1101 4th Street, SW
Washington, DC 20024
Phone (202) 727-5374

Date of Notice: mm/dd/yyyy ___________________	
The Project 1 is:	

Ongoing	

/	

Completed	

/	

Termination

If the Project has been Completed or Terminated,
please provide date of Completion or Termination: mm/dd/yyyy ________________

Contractor	
Name:_______________________________________________________________________________
and					

Contractor’s Registered Agent (if applicable)
Name: _______________________________________________________________________________
Contractor’s or Contractor’s Registered Agent’s Mailing Address (please specify which)
_____________________________________________________________________________________
City/State/Zip: ________________________________________________________________________

Party Against Whose Interest a Lien Is Claimed (herein “Owner”):
Name: _______________________________________________________________________________
and

Owner’s Registered Agent (if applicable):
Name: ______________________________________________________________________________
Owner’s or Owner’s Registered Agent’s Mailing Address (please specify which)
____________________________________________________________________________________
	
City/State/Zip:________________________________________________________________________

Project means any work or materials provided by a contractor for the erection, construction, improvement, repair of, or addition to any real property at the direction of an owner, or an owner’s authorized
agent, or the placing of any engine, machinery or other thing therein or in connection therewith so as to
become a fixture, though capable of being detached. DC Code Section 40-301.03

1

ROD 16 revised 08/2012

Property: Square ____________ Suffix ____________Lot(s) _____________
			

Address:_________________________________________________________________________	
	
	
Washington, DC _______________________

Notice: Notice is hereby given that Contractor indicated above intends to hold a Mechanic’s Lien
against the interest of the Owner of the Property for the sum of $______________ (“Amount Claimed”)
after taking into account any credit for payments through the date hereof. This claim is pursuant to a contract for work or materials in the Project:
			
			

between Owner and the Contractor
between a General Contractor and Contractor which acted as a sub-contractor

Description of the work Done and /or materials Furnished to the Property:

Contractor supplied and/or performed the following (include specific dates of when: 1) work was commenced and completed; and/or 2) materials were furnished, including first and last delivered dates):
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

Certification: The undersigned hereby certifies:
	
Contractor is:		
				
				
				
				
				

an individual
organized and existing under the laws of the District of Columbia.
organized and existing under the laws of the State of __________	
and doing business in the District of Columbia.
organized and existing under the laws of the State of __________	
and not doing business in the District of Columbia.

Delivery of a Copy of Notice: A copy of this notice will be served within five (5) business days of
recordation upon the Owner or the agent of the Owner of the Property by certified mail to the Owner’s
current address (or, if not available in the public records, to the last known address). I further certify that
if the certified mail is returned as unclaimed or undelivered, a copy of this notice will be posted at or on
the affected real property at a location generally visible from some entry point to the real property.
Timing of Notice: This notice is being filed during the construction or within 90 days after the earlier
of the completion or termination of the Project. I further certify that I understand that I must commence
suit to enforce this lien within 180 days from the date of recordation of this notice and that a notice of lis
pendens will need to be recorded timely and pursuant to applicable law.

ROD 16 revised 08/2012

Verification by Contractor, Contractor’s Authorized Representative, or Attorney:
I, ____________________________________________________, hereby affirm under penalty of perjury
and upon my personal knowledge that the contents of this notice are true and correct to the best of my
information and belief, that Contractor has the right to recover the Amount Claimed, and that I am:
			
the Contractor
			
an authorized representative of the Contractor and evidence of my authority to 		
			
execute this notice on behalf of the contractor is appended hereto.
			
an attorney representing Contractor and evidence of my authority to execute
			
this notice on behalf of the contractor is appended hereto.
							
			
					
Signature: ____________________________________________
								
					
Printed Name: _________________________________________
Address: _____________________________________________
					

City/State/Zipcode: _____________________________________

					
	

Telephone: ____________________________________________

State of: ________________________________________________
County of: _______________________________________; ss
This instrument was acknowledged before me on this _____________day of ______________, 20 ___
by ________________________________________________as_____________________________of		
(Name)					
(Title)
____________________________________________________,
(Name of Contractor)	
	
			
					

Notary Public: _______________________________________

							
My commission expires:________________________

ROD 16 revised 08/2012

Required documents that must be included in this notice:
If Contractor is an entity organized under the
laws of the District of Columbia, or is doing
business in the District:
	

Photocopy of current license to do business issued by the
D.C. Department of Consumer and Regulatory Affairs
Certificate of Good Standing issued within 180 days prior
to the date of filing of this notice issued by the D.C.
Department of Consumer and Regulatory Affairs.
If Project is provided under a home improvement contract,
a copy thereof.

If Contractor is an individual or an entity
organized under the laws OTHER than the
District of Columbia, and is not doing business in the District:	

Photocopy of current license to do business in foreign
jurisdiction
Certificate of Good Standing issued within 180 days prior
to the date of filing of this notice issued by the foreign
jurisdiction	
If Project is provided under a home improvement contract,
a copy of thereof.

If Authorized Representative of Contractor
or Attorney is filing this Notice	

Letter of Authorization from Contractor

After recording, return to:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
_______________________________________________________________________________________

ROD 16 revised 08/2012

Letter of Authorization

Date: _____________________
To: __________________________________________________
	
(Name of Authorized Representative or Attorney)

I hereby authorize you to execute and file a Notice of Mechanic’s Lien in the District of
Columbia against _____________________________________________________ to
recover the amount due to us for materials we supplied and/or work we performed.
						
						

________________________________________________
(Name of Contractor)

						
By: ____________________________________________
							
(Signature)
						
							

____________________________________________
(Printed Name)

						
							

____________________________________________
(Title)

ROD 16 revised 08/2012