Fill and Sign the Notice of Contract to Provide Labor and Materialsindividual Form

Notice of Contract to Provide Labor and Materials Page 1 of 2This document prepared by (and after recording return to):Name: Firm/Company: Address: Address 2: City, State, Zip: Phone: ))))))))))--------Above This Line Reserved For Official Use Only------------- NOTICE OF CONTRACT TO PROVIDE LABOR AND MATERIALS- INDIVIDUAL Code Sections 43-4.01 NOTICE TO MECHANIC LIEN AGENT FOR § 43-4.01 NOTICE Delivery by Certified MailDate ______________ Name Mechanic Lien Agent: _________________________________Address: _________________________________City, State, Zip: _________________________________Claimant Name: _____________________________________Address: ___________________________ ___________________________City: ___________________State: ______Zip: ___________Phone: __________________Fax: __________________Building Permit # __________________Date of Permit_________________County/City Permit___________________Property Description on Building Permit: ________________________________________________________________________ ________________________________________________________________________Copy of Building Permit Attached: Yes No The Claimant is providing labor and/or material for the construction of improvements on the property described. CLAIMANT SEEKS PAYMENT FOR LABOR PERFORMED OR MATERIAL FURNISHED. This Notice should be sent within 30 days after Claimant begins work. ________________________________ Claimant ________________________________ Type or Print Name Notice of Contract to Provide Labor and Materials Page 2 of 2Given under my hand this the _____ day of ______________ 20_______. ________________________________(Notary Public or Magistrate, et cetera.)