Fill and Sign the Ks Affidavit Form

SUBCONTRACTOR'S AFFIDAVIT OF WARNING--INDIVIDUAL I, ___________________________________ , am 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 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 Acknowledgment of Individual STATE OF KANSAS COUNTY OF ___________________ This instrument was acknowledged to me on _______________________________ (date) by ________________________________ [name(s) of person(s)]. ______________________________ 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 1 of 1