Fill and Sign the Notice of Labor or Materials Provided Individual Arkansas Form

Notice of Labor or Materials Supplied-Individual (A.C.A.§ 18-44-115(2)(A)-(C)). COMES NOW, __________________________________ , and hereby provides notice of the following: 1. The undersigned, whose address is ____________________________________ , has supplied labor or materials for the improvement of property owned by ___________________________________ , and located at _________________________________________ . 2. Said labor and/or materials were furnished under contract with __________________________________ . 3. A general description of the labor, service, or material furnished by the undersigned: ___________________________________ . 4. The amount due and unpaid as of the date of this notice is $ ________________ . NOTICE TO PROPERTY OWNER IF BILLS FOR LABOR, SERVICES, OR MATERIALS USED TO CONSTRUCT AN IMPROVEMENT TO REAL ESTATE ARE NOT PAID IN FULL, A CONSTRUCTION LIEN MAY BE PLACED AGAINST THE PROPERTY. THIS COULD RESULT IN THE LOSS, THROUGH FORECLOSURE PROCEEDINGS, OF ALL OR PART OF YOUR REAL ESTATE BEING IMPROVED. THIS MAY OCCUR EVEN THOUGH YOU HAVE PAID YOUR CONTRACTOR IN FULL. YOU MAY WISH TO PROTECT YOURSELF AGAINST THIS CONSEQUENCE BY PAYING THE ABOVE NAMED PROVIDER OF LABOR, SERVICES, OR MATERIALS DIRECTLY, OR MAKING YOUR CHECK PAYABLE TO THE ABOVE NAMED PROVIDER AND CONTRACTOR JOINTLY. This the _____ day of ___________ , 20 ______ . _________________________ Signature _____ ____________________ Print or Type Name Notice of Labor or Materials Supplied Page 1 of 2 Certificate of Delivery I, _____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing to ___________________________________ by ( ) Personal Delivery ( ) Mailing a true and correct copy of same by registered mail, return receipt requested , U.S. mail, postage prepaid to ________________________________, at his/her home or usual place of business located at ____________________________________________. So certified this the ______ day of ___________________, 20____. ______________________________ Signature AR § 18-44-115 Notice of Labor or Materials Supplied Page 2 of 2