Fill and Sign the Notice to Real Property Lender Individual Form

Notice to Real Property Lender Page 1 of 3 NOTICE TO REAL PROPERTY LENDER- INDIVIDUAL (Authorized by RCW R.C.W. § 60.04.221) TO: ___________________________________ (Name of Lender) __________________________________________________________________ (Administrative Office-Street Address)__________________________________________________________________ (City) (State) (Zip) AND TO: ___________________________________ (Owner)AND TO: ___________________________________ (Prime Contractor-If Different Than Owner)___________________________________ (Name of Laborer, Professional, Materials, or Equipment Supplier) whose business address is __________________________________________________________________, did at the property located at __________________________________________________________________ (Check appropriate box) ( ) perform labor ( ) furnish professional services ( ) provide materials ( ) supply equipment as follows: ________________________________________________________________________ ________________________________________________________________________which was ordered by ___________________________________ (Name of Person) whose address was stated to be __________________________________________________________________. The amount owing to the undersigned according to contract or purchase order for labor, supplies, or equipment (as above mentioned) is the sum of ___________________________________ Dollars ($______________). Said sums became due and owing as of ______________, ______________ (State Date). You are hereby required to withhold from any future draws on existing construction financing which has been made on the subject property (to the extent there remain undisbursed funds) the sum of ___________________________________ Dollars ($______________). Notice to Real Property Lender Page 2 of 3 IMPORTANT Failure to comply with the requirements of this notice may subject the lender to a whole or partial compromise of any priority lien interest it may have pursuant to RCW 60.04.226. DATE:___________________ By:___________________________________ Its:___________________________________ Certificate of Delivery I, ____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing to __________________________________ by:Personal Service - See attached acknowledgement of serviceMailing a true and correct copy of same by certified or registered U.S. mail, return receipt requested, postage prepaid to ____________________________________, at his/her usual place of business located at _____________________________________________________.So certified this the _____ day of _____________, 20______. ______________________________ Signature ACKNOWLEDGEMENT OF SERVICE The undersigned hereby acknowledges service and receipt of the ___________________________________ regarding the project known as __________________________________ [street address or project name or other identifier], this the _____ day of _____________, 20______. ______________________________ ________________________________ [Prime Contractor] [Owner] _______________________________ _________________________________ [Address of Prime Contractor] [Address of Owner] Notice to Real Property Lender Page 3 of 3By: _____________________________ By: ________________________________ ______________________________ [Construction Lender] _______________________________[Address of Construction Lender]By: ______________________________