Fill and Sign the Massachusetts Corporation Company 497309625 Form

WRITTEN NOTICE OF IDENTIFICATION--CORPORATION (Mass. Gen. Laws Ann. ch. 254 §4) Notice is hereby given to _________________________________ , as contractor, that ___________________________________ , as subcontractor/vendor, has entered into a written contract with _________________________________ to furnish labor or materials, or labor and materials, or rental equipment, appliances or tools to a certain construction project located at ____________________________________ (Street Address), __________________________________ (Town or City), Massachusetts. The amount or estimated amount of said contract is $ _______________ . (No amount need be stated for contracts for the rental of equipment, appliances or tools). This the _____ day of ________________ , 20 ______ . ________________________ Signature _____ ___________________ Type or Print Name _____ ___________________ Title _____ ___________________ Corporation Certificate of Delivery I, _____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing Written Notice of Identification to ___________________________________ by mailing a true and correct copy of same by certified mail, return receipt requested , U.S. mail, postage prepaid to ___________________________, at his/her usual place of business located at ______________________________________. So certified this the ______ day of ___________________, 20____. ______________________________ Signature MA ch. 254, § 4