Fill and Sign the Notice Contest 497302825 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 CONTEST OF CLAIM AGAINST PAYMENT BOND - INDIVIDUAL TO: _________________________ DATE: _____________________ ____________________________________________ ____________________________________________ (lienor's name and address) You are notified that the undersigned contests your notice of nonpayment, dated _____ day of __________________ , _________ , and served on the undersigned on _____ day of _________________ , ________ , and that the time within which you may file suit to enforce your claim is limited to 60 days from the date of service of this notice. DATED on _____ day ___________________ , 20 _____ . Signature of Contractor or Attorney _____ _____________ By (signature) _________________________ Type or Print Name _____ ___________________ Address _____ _____________________________ Notice of Contest of Claim Page 1 of 2 STATE OF ___________ COUNTY OF _____________ Sworn to (or affirmed) and subscribed before me this _____ day of _________________, 20______ by _________________________ (name of person making statement) who is personally known to me or produced _________________________ as identification, and who did take an oath. ____________________________ NOTARY PUBLIC Printed Name of Notary _________________________ Commission Expires _________________________ A copy of this Notice of Contest of Claim Against Payment Bond has been mailed to the lienor at the address shown in the notice of nonpayment or most recent amendment on this __________ day of ________________, 20____. CLERK OF THE CIRCUIT COURT By: ____________________________ As Deputy Clerk (COURT SEAL) Notice of Contest of Claim Page 2 of 2