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New York State Lien Questionnaire on Public Improvement

A mechanic's lien on a state job must be filed with the New York State Comptroller's Office or with the state agency within 30 days from the completion and acceptance of the project by the state agency. To file your lien, fill out this lien questionnaire and hit "submit form". You will be requested to enter your credit card information on a secure site, and be billed $385, calculated as follows: $350 - attorney's fee; $35 - filing fee. For more information on how this service works, please click here.

Name of your company:
Contact:
Email Address:
I prefer to receive my lien via:

Mailing Address (no PO Boxes)
Street:
City:
State:	Zip:
Telephone number:
Fax number:
Full name and title of person signing lien:

Contractor's Address
Name of contractor that hired you:
Street:
City:
State:	Zip:
The exact address where you did the work:
County in which the work was performed:	Other:

Prime Contractor's Name and Address (If you are a sub to a sub-contractor)
Name of prime contractor:
Street:
City:
State:	Zip:

Owner's Address
Name of owner of the premises:
Street:
City:
State:	Zip:
Describe labor performed:
Describe materials provided:
Describe materials fabricated that were not put in the job:
What is the total amount of lien:

Project Details
Project name and description:
City agency involved:	Other:
Contract number:
Controller number:
Date when the monies became due:
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