Fill and Sign the Notice Mechanic Lien Form

NOTICE OF POSSIBLE MECHANIC’S LIEN - CORPORATION (R.I. Gen. Laws §34-28-4.1) To: _________________________________ . (insert name of owner, lessee or tenant, or owner of less than the fee simple). The undersigned is about to perform work and/or furnish materials for the construction, erection, alterations, or repair upon the land at ________________________________________________________________________ under contract with you. This is a notice that the undersigned and any other persons who provide labor and materials for the improvement under contract with the undersigned may file a mechanic’s lien upon the land in the event of nonpayment to them. It is your responsibility to assure yourself that those other persons under contract with the undersigned receive payment for their work performed and materials furnished for the construction, erection, alteration or repair upon the land. _______________________________ Signature _____ __________________________ Type or Print Name _____ __________________________ Title _____ __________________________ Name of Corporation _____ __________________________ _______________________________ Address Certificate of Delivery I, _____________________________________ , hereby certify that I have delivered this day a true and correct copy of the foregoing to ___________________________________ by mailing a true and correct copy of same by certified U.S. mail, postage prepaid, return receipt requested to __________________________________ . So certified this the _____ day of _____________ , 20 ______ . ________________________ Signature Notice of Possible Mechanic’s Lien Page 1 of 1