Fill and Sign the Name Ampamp Address Changesyakima County Wa Form

Subcontractor’s Notice of Claim of Lien Page 1 of 3Prepared by, recording requested by and return to:Name: Company: Address: City: State: Zip: Phone: Fax: Parcel Identification Number:Legal Description:----------------------Above this Line for Official Use Only--------------------- SUBCONTRACTOR'S NOTICE OF CLAIM OF LIEN--CORPORATION (Iowa Code § 572.10) COMES NOW, ____________________________, as a representative of _____________________ a __________________________ corporation which has furnished labor or materials for the improvement of property described as ___________ _______________________________________________________________________, and would state as follows: 1.The undersigned began furnishing labor and/or materials to the above-described property on the ____ day of ___________, 20___, and completed furnishing the same on the ____ day of ______________, 20___. 2.The name and last known mailing address of the owner, agent, or trustee of the property is ______________________________________________________________.3.An accounting of the material furnished or labor performed:Material Furnished/Labor Performed Date(s)Amount Due________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Subcontractor’s Notice of Claim of Lien Page 2 of 34. The total amount due the undersigned, allowing for all credits is $ ____________.5.The above listed labor and/or material was furnished under agreement with principal contractor, _____________________________. On information and belief, said contractor has not filed a verified statement of account within ninety (90) days from the date of the last furnishing of labor or material. This the ______ day of _______________________, 20____. ______________________________Signature ______________________________Title______________________________Corporation I, _______________________________, do hereby swear or affirm that the matters alleged and things contained in the above Verified Statement of Account are true and correct to the best of my knowledge, information, and belief. ________________________Affiant Acknowledgment of Corporation STATE OF IOWACOUNTY OF _________________ On this ____________ day of ______________________, ______________, before me, a Notary Public, in and for said county, personally appeared ________________________________________, to me personally known, who being by me duly (sworn or affirmed) did say that that person is _________________________________________ (Insert title of executing officer) of said ______________________________________ (corporation or association) and that said instrument was signed on behalf of the said ____________________________________ (corporation or association) by authority of its board of ______________________________ (directors or trustees) and the said __________________________ acknowledged the execution of said instrument to be the voluntary act and deed of said _____________________________________________ (corporation or association) by it voluntarily executed. ______________________________ Notary Public My Commission Expires: ____________________ (SEAL) Subcontractor’s Notice of Claim of Lien Page 3 of 3 Certificate of Delivery I, _____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing to ___________________________________ by: ( )Personal Service ( )Mailing a true and correct copy of same by certified U.S. mail, postage prepaid, return receipt requested to _____________________________________.So certified this the ______ day of ___________________, 20____. ________________________ Signature