Fill and Sign the Notice Contractor Form

Notice to Contractor Page 1 of 1 NOTICE TO CONTRACTOR- INDIVIDUAL TO: ___________________________________ DATE: __________________________________ __________________________________ __________________________________ (contractor's name and address) The undersigned hereby informs you that he or she has furnished or is furnishing services or materials as follows: ____________________________________________________________________________ (general description of services or materials) for the improvement of the real property identif ied as: (legal description of property) ______________________________________________________________________________ ______________________________________________________________________________ owned by: (owner's name and address) ______________________________________________________________________________ under an order given by: ___________________________________ (give name of the person who contracted with the undersigned) and that the undersigned will look to the contractor's bond for protection on the work. (Optional language) The undersigned hereby requests a copy of the payme nt bond pertaining to the improvements for this project and agrees to pay reasonable copy costs for same. __________________________________ (Lienor’s signature ) Type or Print Name : _____________________________ Address: ______________________________________ Certificate of Service I, _____________________________________, hereby certify that I have deliv ered this day a true and attested copy of the foregoing to ___________________________________ by: ( ) Actual Delivery to the person to be served. ( ) Mailing a true and correct copy of same by registered or certified U.S . mail, with postage prepaid, or by overnight or second-day delivery with evidence of delivery. ( ) If service cannot be made by the above methods, by posting on the premises. ________________________ Signature