VA Acceptance of Appointment as Mechanic's Lien Agent

ACCEPTANCE OF APPOINTMENT AS
MECHANIC'S LIEN AGENT

Date: ______________________________

To: _______________________________

                          _______________________________

                          _______________________________

Dear: ______________________________

Pursuant to your request, please be advised that _________________________________

accepts your appointment as “Mechanic's Lien Agent” on the following construction site:

___________________________________________________ (Property Street Address)

a/k/a                LOT___________ BLOCK______________SECTION _________________                          SUBDIVISION:_________________________________________________

       COUNTY: _______________________________________________, Virginia

NOTE: USE ONLY LEGAL DESCRIPTION OF PROPERTY. DO NOT USE YOUR JOB #.

                          You may designate ______________________________________ as "Mechanic's Lien Agent" on the Building Permit issued or to be issued for construction on the above property. Furnish us with a copy of the Building Permit at your earliest convenience.

Respectfully submitted,

____________________________________ (Name)

____________________________________ (Entity)

____________________________________ (Street Address)

____________________________________ (City/State/Zip)

____________________________________ (Telephone Number)

____________________________________ (Facsimile Number)

____________________________________ (E-mail address)