Fill and Sign the Notice Commencement Form 497322122

NOTICE OF COMMENCEMENT-Individual (Ohio Revised Code Section 1311.04) State of Ohio County of ____________________ __________________________________ , whose address is _____________________________________________________________________________ , being first duly sworn, states: 1. Notice is hereby given that _______________________________________ [Company or Person Undertaking Improvement] intends to commence work on real property described as: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ [The legal description of the real property on which the improvement is to be made sufficient to describe the real property for the purpose of conveyance, or contained in the instrument, by which the owner, part owner, or lessee took title.] 2. A brief description of the improvement to be performed on the property containing sufficient specificity to permit lien claimants to identify the improvement is: ________________________________________________________________________ _______________________________________________________________________ . 3. The name, address and capacity of the Owner, Part Owner, or Lessee of the real property contracting for the improvement is: ________________________________________________________________________ _______________________________________________________________________ . 4. The name and address of the fee owner of the real property, if the person contracting for the improvement is a land contract vendee or lessee is: ________________________________________________________________________ _______________________________________________________________________ . Notice of Commencement Page 1 of 4 5. The name and address of the Owner’s, Part Owner’s or Lessee’s Designee, if any is: ________________________________________________________________________ _______________________________________________________________________ . 6. The name and address of all the original contractor(s) (except that if improvement involves a single- or double-family dwelling and if more than one original contractor is involved, instead of listing each original contractor, include statement that multiple original contractors are involved in the improvement) is/are: ________________________________________________________________________ ________________________________________________________________________ 7. The date the Owner, Part Owner, or Lessee first executed a contract with an original contractor for the improvement is: ___________________________________ . 8. The name and address of all lending institutions which provide financing for the improvements, if any is/are: ________________________________________________________________________ _______________________________________________________________________ . 9. The name and address of all sureties on any bond which guarantee payment of the original contractor’s obligations under the contract for the improvement, if any is/are ________________________________________________________________________ _______________________________________________________________________ . 10. Notice: "To Lien Claimants and Subsequent Purchasers: Take notice that labor or work is about to begin on or materials are about to be furnished for an improvement to the real property described in this instrument. A person having a mechanics' lien may preserve the lien by providing a notice of furnishing to the above-named designee and the above-named designee’s original contractor, if any, and by timely recording an affidavit pursuant to section 1311.06 of the Revised Code. A copy of this notice may be obtained upon making a written request by certified mail to the above-named owner, part owner, lessee, designee, or the person with whom you have contracted." 11. The name and address of the person preparing this Notice is: ________________________________________________________________________ _______________________________________________________________________ . Notice of Commencement Page 2 of 4 THIS the _____ day of _______________ , 20 ______ . By: ___________________________________ Type or Print Name: _____ ________________ Acknowledgment of Individual STATE OF OHIO COUNTY OF _____________________ The foregoing instrument was acknowledged before me this _____________________ (date) by _________________________________________ (name of person acknowledged.) ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________ VERIFICATION State of Ohio County of ____________ The undersigned Affiant, being duly sworn states: That I, the undersigned, the Owner, Part Owner, Lessee, or the agent of the Owner, Part Owner, Lessee of the real property on which the improvement is to be made, have read and understood the Notice of Commencement and that the allegations in the above Notice of Commencement are true and correct, to the best of my knowledge, information and belief. Given on this the _____ day of _________________, 20 _____. ____________________________________ Name Of Affiant This Instrument was prepared by: Notice of Commencement Page 3 of 4                         Signature       Print or Type Name Notice of Commencement Page 4 of 4