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(Consolidated up to 182/2016)


Woodmens Lien Act


1   The forms in the Schedule are the forms prescribed for the purposes of the sections of the Act indicated on the forms.

2   The Forms Regulation (AR 499/81) is repealed.

3   Repealed AR 182/2016 s2.


Form 1

s Lien Act
(Section 8)

Statement of Claim of Lien

  ( Name of claimant )    of    ( state residence of claimant ) , or (name of assignee)  as assignee of ( state name and address of assignor ) claims, under the Woodmen’s Lien Act, a lien on certain logs, timber or lumber, the property of ( state the name and residence of the owner of logs, timber or lumber on which the lien is claimed, if known ).  The logs, timber or lumber are composed of    ( state the kinds of logs, timber or lumber such as spruce, tamarac, cedar, or other logs, such as ties, poles, etc., and where situated at the time of filing of statement ) in respect of the following work:   ( give a short description of the work done for which the lien is claimed )  .  The work was done for ( state the name and residence of the person on whose credit the work was done ) between the                    day of               and the              day of                    at  ( per day, month or quantity ) .

The amount claimed as due or to become due is the sum of                .   (Or when credit has been given:  The said work was done on credit, and the period of credit will expire on                                              .)

                                                                       (Signature of claimant)

Woodmens Lien Act

Affidavit to be Attached to Statement of Claim

I,                                      , make oath and say that I have read ( or have heard read ) the foregoing statement of claim, and I say that the facts set forth in it are, to the best of my knowledge and belief, true and the amount claimed to be due to me in respect of my lien is due and owing to me after giving credit for all the money, goods or merchandise to which (naming the debtor) is entitled to credit as against me.

Sworn before me at                       in the                    of              this               day of                                    .

                                                                       (Signature of claimant)

      A Commissioner, etc.

Form 2

s Lien Act
(Section 2)




       (period employed)






No. days employed

Rate per day

Total amount earned

Amount paid

Date of pay-ment

Re-ceived pay-ment in full









I hereby certify that the above statement is correct to the best of my knowledge and belief, and is made by me in compliance and in accordance with section 2 of the Woodmen’s Lien Act, on account of ( my contract, or my employment ).  The work done was  ( insert brief description of the work)  for (owner’s name) up to                              .


Dated                                        .