Oregon Statutes 416.560 – Form of notice of lien
The form of the notice required by ORS § 416.550 (1) shall be substantially as follows:
Terms Used In Oregon Statutes 416.560
- City: includes any incorporated village or town. See Oregon Statutes 174.100
- Lien: A claim against real or personal property in satisfaction of a debt.
- Oath: A promise to tell the truth.
- Person: includes individuals, corporations, associations, firms, partnerships, limited liability companies and joint stock companies. See Oregon Statutes 174.100
- public body: means state government bodies, local government bodies and special government bodies. See Oregon Statutes 174.109
- Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
______________________________________________________________________________
Notice is hereby given that the ________ has rendered assistance to____________, a person who was injured on or about the ___ day of ______ in the city of ______ and State of______, and the ________ hereby asserts a lien to the extent provided in ORS § 416.510 to 416.610, for the amount of such assistance upon any amount due and owing ________ (name of injured person) under a judgment, settlement or compromise from ______ alleged to have caused such injuries and from any other person or public body, agency or commission liable for the injury or obligated to compensate the injured person on account of such injuries.
Department of Human Services/Oregon Health Authority
by____________,
Director of ________ or designee.
I, ____________, being first duly sworn on oath say: That I am the Director of ________ or designee; that I have read the foregoing notice of lien and know the contents thereof and believe the same to be true.
______________________________________________________________________________ [Formerly 411.562; 1969 c.597 § 251; 2001 c.600 § 6; 2009 c.595 § 350]