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Fill and Sign the Notice of Contest of Claim Against Payment Bond Individual Form

Fill and Sign the Notice of Contest of Claim Against Payment Bond Individual Form

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Notice of Contest of Claim Page 1 of 2Prepared by, recording requested by and return to:Name: ___________________Company: ___________________Address: _____________________City: __________________________State: _____Zip: _____________Phone: _____________________Fax: _______________________----------------------Above this Line for Official Use Only--------------------- 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 2 of 2STATE 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 PUBLICPrinted 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)

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