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Fill and Sign the Full Text of Ampquotthe National Government of the United Statesampquot Form

Fill and Sign the Full Text of Ampquotthe National Government of the United Statesampquot Form

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Public Demand for Payment Page 1 of 1 PUBLIC DEMAND FOR PAYMENT -- INDIVIDUAL (§779.15(3), Wis. Stats.) 1. CLAIMANT: ________________________________ Name: ________________________________ Address: _________________________________________________________ 2. PUBLIC ENTITY: ______________________________________ (State/County/Town/Municipality/Other) 3. DATE OF CLAIM FOR PUBLIC IMPROVEMENT LIEN: The _____ day of _______________, 20______. 4. PROJECT NUMBER: _________________________________ 5. AMOUNT CLAIMED: $ ________________. 6. DATE OF SERVICE ON PRIME CONTRACTOR: ______________________ (attachment of a copy of Claim for Public Improvement Lien and Registered Mail Return Receipt or Affidavits of Hand Delivery recommended) Claimant has filed a valid Claim for Public Improvement Lien on the above date, and, to the best of Claimant's knowledge, Prime Contractor has not disputed this Claim within thirty (30) days after service on the Prime Contractor. Therefore, Claimant makes demand on the Public Entity for immediate payment pursuant to §779.15(1), Wis. Stats. This the ______ day of ______________, 20______. __________________________________ Signature__________________________________ Type or Print Name

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