Fill and Sign the Notice of Furnishing Corporation or Llc Kentucky Form

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 -Corporation (K.R.S.A. § 376.010(2)) COMES NOW, __________________________________ , as a representative of _________________________________ , a __________________________________ corporation which may be served with process through its Agent, ____________________________________ at the following address _______________________________________________________________________ , and would state as follows: 1. The undersigned corporation ( ) has furnished ( ) will furnish labor or materials for the improvement of the property located at _______________________________________________________________________ and described as _______________________________________________________________________ . 2. The above-mentioned property is owned by _____________________________________ . 3. The value of the labor and/or materials in full, with all credits and setoffs known to the undersigned, is $ _____________ . 4. The above-mentioned labor and materials were furnished by the undersigned corporation under contract with ( ) the property owner, ( ) a contractor, ( ) a subcontractor. 5. The undersigned is entitled to a lien for the above amount, said lien being superior to any mortgage or encumbrance created subsequent to the beginning of the labor or the furnishing of the materials, and the lien shall relate back and take effect from the time of the commencement of the labor or the furnishing of the materials. The lien shall take precedence over a mortgage or other contract lien or bona fide conveyance for value without notice, as this Notice of Furnishing statement showing that the undersigned has furnished or expects to furnish labor or materials, and the amount in full thereof, shall be Notice of Furnishing Page 1 of 3 filed in the office of the county clerk of the county wherein the undersigned furnished or expects to furnish labor or materials, before the recording of the mortgage or other contract lien or conveyance. ______________________________ Signature _____ _________________________ Type or Print Name _____ _________________________ Title _____ _________________________ Corporation Attest: Secretary State of Kentucky County of __________________ The foregoing instrument was acknowledged before me this the ___ day of _______________, 20___, by ___________________________________________ (name of officer or agent, title of officer or agent) of _____________________________________ (name of corporation acknowledging) a ____________________________________ (state or place of incorporation) corporation, on behalf of the corporation. ______________________________ Notary Public Title (and Rank): _______________ Print Name: ___________________ (Serial number, if any)___________ (Seal, if any) My commission expires: ____________________ Notice of Furnishing Page 2 of 3 Certificate of Delivery I, _____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing to ___________________________________, the property owner at his or her last known address within seven (7) days of filing the statement with the county clerk, by: ( ) Regular Mail ( ) Registered Mail ( ) 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 Furnishing Page 3 of 3