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Fill and Sign the List of Material and Supplies Provided Corporation or Llc Oregon Form

Fill and Sign the List of Material and Supplies Provided Corporation or Llc Oregon Form

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LIST OF MATERIALS AND SUPPLIES PROVIDED – CORPORATION (Or. Rev. Stat. §87.057(2)) COMES NOW, __________________________________ , as a representative of _________________________________ a _______________________________ corporation that intends to foreclose a lien on property located at and described as ________________________________________________________________________ ________________________________________________________________________ and states the following: 1. The undersigned provided a Notice of Intent to Foreclose pursuant to Or. Rev. Stat. §87.057 to _________________________________ (owner of the property upon which the lien is claimed) on the _____ day of _________________ , ______ . 2. The undersigned received from the owner a demand to furnish a list of materials and supplies with the charge therefore, for which a claim will be made in the suit to foreclose. 3. The undersigned hereby provides the following list of materials and supplies with the charge therefore, for which a claim will be made in the suit to foreclose, within five (5) days of such demand: Materials/Supplies Provided Date Cost/Value ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ . This the _____ day of ____________ , 20 ______ . ______________________________ Signature _____ _________________________ Type or Print Name _____ _________________________ Title _____ _________________________ Name of Corporation List of Materials and Supplies Provided Page 1 of 2 Certificate of Delivery I, _____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing to ___________________________________ by: ( ) Personal Delivery ( ) Mailing a true and correct copy of same by certified or registered U.S. mail, postage prepaid, return receipt requested. So certified this the ______ day of ___________________, 20____. ________________________ Signature List of Materials and Supplies Provided Page 2 of 2

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