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[ASSOCIATION NAME] — NOTICE OF ASSESSMENT LIEN
A lien recorded against real property for delinquent HOA assessments
Free template from The HOA Guide — thehoaguide.com
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ASSOCIATION INFORMATION
   Association name: __________
   Mailing address: __________
   City, State, ZIP: __________
   Contact person: __________
   Phone: __________   Email: __________

PROPERTY DESCRIPTION
   Street address: __________
   City, State, ZIP: __________
   County: __________
   Legal description (lot, block, subdivision): __________
   Assessor's Parcel Number (APN): __________

OWNER INFORMATION
   Owner name(s): __________
   Mailing address (if different from property): __________
   City, State, ZIP: __________

DELINQUENT AMOUNTS (itemize each period)
   Period          Assessment due    Amount
   __________      __________        $__________
   __________      __________        $__________
   __________      __________        $__________

   Subtotal — unpaid assessments:              $__________
   Late fees:                                  $__________
   Interest (rate: ____%):                     $__________
   Attorney fees:                              $__________
   Collection costs:                           $__________
   Recording fees:                             $__________
   Other charges (describe): __________        $__________

   TOTAL AMOUNT OF LIEN:                       $__________

AUTHORITY
   This lien is recorded pursuant to the association's Declaration of
   Covenants, Conditions, and Restrictions (CC&Rs), specifically:
   Article/Section: __________
   Recorded on: __________  Book: __________  Page: __________
   County: __________

   Applicable state statute (if any): __________

   The CC&Rs grant the association the right to record a lien against any
   lot or unit for which assessments remain unpaid after the due date.

RECORDING INFORMATION
   County recorder's office: __________
   Date of recording: __________
   Document/instrument number: __________

PRIOR NOTICE TO OWNER
   Notice of delinquency mailed on: __________
   Method: [ ] First-class mail  [ ] Certified mail  [ ] Both
   Sent to address: __________

CERTIFICATION
   The undersigned certifies that the amounts stated above are true and
   correct and that prior notice of delinquency was provided to the
   owner as required by the CC&Rs and applicable law.

   Authorized signature: __________
   Printed name: __________
   Title: __________
   Date: __________

NOTARIZATION (if required by state law or CC&Rs)
   State of __________  County of __________
   Subscribed and sworn before me on __________
   Notary signature: __________
   Commission expiration: __________

OWNER'S RIGHT TO DISPUTE
   The property owner has the right to:
   [ ] Request an itemized statement of the amounts owed
   [ ] Request a hearing or meeting with the board
   [ ] Dispute the lien through the association's internal dispute
       resolution process
   [ ] Pursue mediation or other remedies available under state law

   To dispute this lien, contact the association in writing at the
   address listed above within __________ days of this notice.

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This template is for informational purposes only and is not legal
advice. Lien recording requirements vary by state. Consult a qualified
attorney before recording a lien against real property.