Fill and Sign the Notice Intent File Form

SUBCONTRACTOR NOTICE OF INTENTION TO FILE CLAIM FOR LIEN – CORPORATION (§779.06(2), Wis. Stats.) OWNER'S NAME: __________________________________ OWNER'S ADDRESS: ________________________________________________________________________ The undersigned Subcontractor, having contracted with __________________________ , (name of party with whom Subcontractor contracted) provided materials and/or labor for: ________________________________________________________________________ ________________________________________________________________________ (describe work performed) to improve your property located at: ________________________________________________________________________ and, as of the date of this Notice, is owed the sum of $ _______________ . Notice is hereby provided that if payment in full is not received within thirty (30) days from the date of this Notice, the Subcontractor intends to file a Claim for Lien on your Property. This is the _____ day of ______________ , 20 ______ . _____________________________ Signature _____ ________________________ Type or Print Name _____ ________________________ Title _____ ________________________ Corporation _____ ________________________ _____________________________ Address Certificate of Delivery I, ___________________________________ , hereby certify that I have delivered this day a true and correct copy of the foregoing to property owner ___________________________________ by: ( ) Personal Delivery ( ) Mailing a true and correct copy of same by registered U.S. mail, postage prepaid, return receipt requested to __________________________________ . So certified this the _____ day of __________________ , 20 ______ . ________________________ Signature Subcontractor Notice of Intention to File Claim for Lien Page 1 of 1