Fill and Sign the Ma Corporation 497309585 Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ______________________ Company: _____________________ Address: ____________________ City: ___________________ State: _______ Zip: __________ Phone: ______________ Fax: _____________ NOTICE OF CONTRACT--CORPORATION (Mass. Gen. Law Ann. ch. 254 §2) Notice is hereby given that by virtue of a written contract dated the _____ day of _____________ , 20 _______ , between __________________________________ , Owner, and ____________________________________ , Contractor, said Contractor is to furnish or has furnished labor and material or rental equipment, appliances or tools for the erection, alteration, repair or removal of a building, structure, or other improvement on a lot of land or other interest in real property described as follows: ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________________________________ . [Legal Description of Property] This the _____ day of _______________ , 20 ________ . ________________________ Signature _____ ___________________ Type or Print Name _____ __________________ Title _____ ___________________ Corporation Attest: Secretary State of Massachusetts County _____________ On this _______ day of _________, 20 ___, before me the undersigned notary public, personally appeared ________________________________________ (name of document signer), proved to me through satisfactory evidence of identification, which were _________________________________, to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he or she signed it voluntarily for its stated purpose (as ____________ for ______________, a corporation). _____________________ Notary Public Print Name: ___________________ My commission expires: ____________________