Fill and Sign the Notice Commencement Form 497311287

REQUEST FOR COPY OF NOTICE OF COMMENCEMENT--INDIVIDUAL (M.S.A. § 570.1108(5)-(7)) COMES NOW, __________________________________ , a subcontractor, supplier, or laborer, who has provided an improvement to the real property located at _______________________________________________________________________ , and having provided this request via certified mail, would state the following: 1. Michigan statutes require that within ten (10) days from the date of mailing of this Request, the contractor, subcontractor, owner, lessee, or owner’s designee, who is the recipient of this request shall provide a copy of the Notice of Commencement along with a blank Notice of Furnishing to the undersigned subcontractor, supplier, or laborer, at the following address: _______________________________________________________________________ . 2. Failure to provide a copy of the Notice of Commencement per this request shall serve to extend the time within which a subcontractor or supplier may provide a notice of furnishing until twenty (20) days after the Notice of Commencement has been received by the subcontractor or supplier, and the time within which a laborer may provide a Notice of Furnishing to thirty (30) days after the Notice of Commencement has been received by the laborer, or until the time within which to provide the Notice of Furnishing expires, whichever is later. THIS the _____ day of _______________ , 20 _____ . ______________________________ Subcontractor, Supplier, or Laborer Request for Copy of Notice of Commencement Page 1 of 2 _____ _________________________ Type or Print Name CERTIFICATE I, _____________________________________ , certify that I have this day mailed a true and correct copy of the foregoing Written Request for Copy of Notice of Commencement to _______________________________________ at the following address: ______________________________________________________________ by Certified U.S. Mail, postage pre-paid. THIS the _____ day of ______________ , 20 ________ . ______________________________ Signature MI § 570.1108 Request for Copy of Notice of Commencement Page 2 of 2