Fill and Sign the Notice to Mechanic Lien Agent and Owneragent Individual Form

Notice to Mechanic Lien Agent and Owner/Agent 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 TO MECHANIC LIEN AGENT AND OWNER/AGENT- INDIVIDUAL Code Sections 43-4.01 and 43-11 NOTICE TO MECHANIC LIEN AGENT FOR § 43-4.01 NOTICE Delivery by Certified MailDate ________________ Name Mechanic Lien Agent: __________________________________Address: _____________________________________________________________________City: _____________________: State: _____Zip: ____________Phone: _______________Fax: _________________Building Permit # ___________________Date of Permit_________________County/City_______________Property Description on Building Permit: ______________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________Nature and Character of Claimant’s Contract (Type of Labor or Material to be Provided): ___________________________________________________________________________ NOTICE TO OWNER/AGENT FOR § 43-11 NOTICE Delivery by Certified MailDate:____________________ Name of Owner Agent: __________________________________Address: __________________________________________________________________City, State, Zip: _________________________________________________Claimant Name: ____________________Address:_________________________________________ ________________________________________________________________________________________________City: __________________State: _______Zip: ____________Phone: _________________Fax: _________________ Notice to Mechanic Lien Agent and Owner/Agent Page 2 of 2General Contractor Name: _________________________________Address: __________________________City: __________________State: _____Zip: _____________Building Permit # __________________Date of Permit_________________County/City__________________Copy of Building Permit attached: Yes No The Claimant is providing labor and/or material for the construction of improvements on the property described. The anticipated value of the labor and/or material to be provided and the probable amount of the claim will be ___________________________________ dollars ($______________). CLAIMANT SEEKS PAYMENT FOR LABOR PERFORMED OR MATERIAL FURNISHED. This Notice may create personal liability on the part of the Owner and General Contractor to pay this Claimant. This Notice should be sent before the Claimant begins work, if possible, under Virginia Code § 43-11 or within 30 days after Claimant begins work under Virginia Code § 43-4.01. __________________________________Signature___________________________________Type or Print Name Given under my hand this the _____ day of ______________ 20_______. ________________________________(Notary Public or Magistrate, et cetera.)