Fill and Sign the Notice of Furnishing Absent Contract Individual Form

Notice of Furnishing Absent Contract Page 1 of 2 Prepared by, recording requested by and return to: ---------------------- Above this Line for Official Use Only --------------------- Name: ______________________ Company: _____________________ Address: ______________________ City: __________________ State: _______ Zip: __________ Phone: __________________ Fax: __________________ Notice of Furnishing Absent Contract - Individual (M.R.S.A. § 3253) COMES NOW, __________________________________ , as a party which has provided labor, materials, or services toward the improvement of property described as _____________________________________________________________________ , and owned by _______________________________ , and would state as follows: 1. The undersigned provided the following labor, materials, or services for the improvement of the above mentioned property without the benefit of a contract with the property owner: ________________________________________________________________________ __________________________________________________ ______________________ __________________________________________________________ . 2. The undersigned ceased providing labor, materials, or services on the _____ day of ________________ , 20 _____ , being within ninety (90) days of the filing of this document. 3. The undersigned is entitled to a lien in the amount of $ ______________ in compensation for labor, materials, or services provided after giving due credit for payments received. 4. That pursuant to Maine Revised Statute Annotated §3253 any attempt by the property owner to deny responsibility for labor, materials, or services furnished without a contract and dissolve the lien of the undersigned should be denied. _____________________________ Signature _____ ________________________ Type or Print Name Notice of Furnishing Absent Contract Page 2 of 2 Date _______________________ State of Maine County of __________________ The foregoing instrument was acknowledged before me this the ______ day of ______________, 20__ by _______________________(name of person acknowledged). ___________________________________ Signature of Notary Public ___________________________________ Na me of N otary Public Notary Public, State of Maine My commission expires: ____________________