Sec. 34.35.465. - Form of notice.

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