Fill and Sign the Kansas Subcontractor Form

SUBCONTRACTOR'S AFFIDAVIT OF WARNING--CORPORATION I, ________________________________ , am a representative of _________________________________ a ________________________________ corporation acting in the capacity of a supplier/subcontractor/or other person furnishing labor, equipment, material or supplies, used or consumed at the site of the property subject to the lien which is located at ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ . A warning statement was required to be given pursuant to K.S.A. 60-1103a, and amendments thereto. I am hereby attaching to this Lien Statement this affidavit that such warning statement was properly provided to the owner, by personal service or by first class mail, postage prepaid, on the _____ day of _________________ , 20 ______ . This the _____ day of ________________ , 20 ______ . ______________________________ Signature _____ _________________________ Type or Print Name _____ _________________________ Title _____ _________________________ Corporation I, _______________________________, do hereby swear or affirm that the matters alleged and things contained in the above Subcontractor's Affidavit of Warning are true and correct to the best of my knowledge, information, and belief. __________________ Affiant Subcontractor’s Affidavit of Warning Page 1 of 2 Acknowledgment of Corporation STATE OF KANSAS COUNTY OF ___________________ This instrument was acknowledged before me on __________________________ (date) by ___________________________________________ [name(s) of person(s)] as _____________________________________________________ (type of authority, e.g., officer, trustee, etc.) of _____________________________________ (name of party on behalf of whom instrument was executed.) _____________________________ Notary Public _____________________________ Type or Print Name ______________________________ Title (and Rank) (Seal, if any) My appointment expires: _____________________ KS § 60-1103(a)(2) Subcontractor’s Affidavit of Warning Page 2 of 2