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The form of notice required by AS 34.35.450 - 34.35.480 shall be substantially as follows:
NOTICE is hereby given that . . . . . . . . . . . . has rendered
services for hospitalization, physician services, or special nurses'
services for . . . . . . . . . . . ., a person who was injured on the .
. . . day of . . . . . . at . . . . . . . in the state, and the . . . .
. . . . . . . . . . . . (claimant) hereby claims a lien upon any money
due or owing or any claim for compensation, damages, contribution,
settlement, or judgment from . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . alleged to have caused the
injuries and any other person liable for the injury or obligated to
compensate the injured person on account of the injuries; the
hospitalization, physician services, or special nurses' services were
rendered to the injured person between the . . . . day of . . . . . and
. . . . . . . . . . . . . . . . . .:
General Description of Services Rendered and
Statement of Amount Due
.......................................................................
and that 90 days have not elapsed since that time; that the claimant's
demands for care and service is in the sum of $. . . . . . . . and that
no part of the demands has been paid, except $. . . . . . . . . ., and
that there is now due and owing and remaining unpaid thereof, after
deducting all credits and offsets, the sum of $. . . . . ., in which
amount lien is hereby claimed.
United States of America
State of Alaska ss.
. . . . . . . . . . Judicial District
I, . . . . . . . . . . . . . . . . . . . . . . . . . ., being first
duly sworn on oath say: That I am . . . . . . . . . . . . . . . . . .
. . . . . . . . . . named in the foregoing claim of lien; that I have
read the same and know the contents thereof and believe the same to be
true.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Subscribed and sworn to before me this . . . . . . day of . . . . . . .
. . . . . . . . ., 2. . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Notary Public for Alaska
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