Alaska § 34.35.465 - Form of notice.

§ 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 AmericaState of Alaska ss.......... Judicial DistrictI, ....................................................., 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...............................................................