I would ONLY ask an attorney to prepare that -- mainly because you're talking a lien against a house.
And that's probably on file at the county's records office.
And that's gonna get looked at for many years down to the road when you sell the house, and the buyer's side does a title search to make sure that you're the legal owner. And they usually go back many many years etc...
Sorry...have no clue how to even get started, never even heard of it, BUT I'd only get an attorney to do that.