Fill and Sign the Massachusetts Notice 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 --INDIVIDUAL (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 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 o n the preceding or attached document, and acknowle dged to me th at he or she signed it voluntarily for its stated purpose. _____________________ Notary Public Print Name: ___________________ My commission expires: ____________________