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 Dueand 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 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 Notary Public for Alaska
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