Fill and Sign the Notice of Intent to Perform Individual

Notice of Intent to Perform Page 1 of 1 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 INTENT TO PERFORM --INDIVIDUAL (Kan. Stat. Ann. § 60 -1103b) I, _______________________________________, (name of supplier, subcontractor or contractor) whose address is ___________________________________ _____________________________________________, do hereby give public notice that I am a supplier, subcontracto r or contractor or other person providing materials or labor on property owned by _____________________________________, and having the legal description as follows: ________________________________________________________________________ _________________ _______________________________________________________ ________________________________________________________________________ . [Legal Description of Property] This the ____ day of ____________________, 20____. ______________________________ Signature STATE OF KANSAS COUNTY OF ___________________ This instrument was acknowledged to me on _______________________________ (date) by ________________________________ [name(s) of person(s)]. ______________________________ Notary Public Pr int Name: ___________________ My commission expires: __________________