Fill and Sign the Ohio Corporation Form

      REQUEST FOR LIEN INFORMATION - CORPORATION (Ohio Revised Code Section 1311.011(B)(8)) State of Ohio County of _________________ ___________________________________ , as President of _____________________________ , a ________________________ corporation, whose address is ___________________________________________________ , being first duly sworn, states: 1. Whereas it has come to the attention of ___________________________________ [Contractor or Lending Institution] _________________________________ that a dispute has arisen regarding the amount due and owing to subcontractor, material supplier, or laborer, ___________________________________ , by the original contractor, _________________________________ , and 2. Further, that above named subcontractor, material supplier, or laborer, has refused to supply a lien release to the original contractor, owner, part-owner, lessee, or lending institution as a result of this dispute, 3. That pursuant to Ohio Revised Code 1311.011(B)(8) the owner, part owner, or lessee shall withhold the amount of disputed payment from the contractor until such time as a lien release is obtained or the subcontractor, material supplier, or laborer gives written notice to the owner, part-owner, lessee, or lending institution that the amount of money claimed to be due has been paid, or the original contractor provides the subcontractor, material supplier, or laborer with a bond in the amount claimed by subcontractor, material supplier, or laborer. 4. That pursuant to Ohio Revised Code 1311.011(B)(8) the Contractor or Lending Institution hereby give notice to the subcontractor, material supplier, or laborer that they have ten days from receipt of this notice to respond in writing and advise of the amount due and the last date the subcontractor, material supplier, or laborer performed any labor or work or furnished any material to the owner or contractor. 5. Failure to respond within ten days shall result in the information required regarding the amount due and the last date of work being supplied to the owner and lending institution by the original contractor. Request for Lien Information – Corporation Page 1 of 2 THIS the _____ day of _________________ , 20 ______ . By: ___________________________________ Type or Print Name: _____ _________________ Name of Corporation: _____ _______________ Title: _____ _____________________________ Witness: __________________________________ Witness: __________________________________ STATE OF OHIO, COUNTY OF       ACKNOWLEDGED, SWORN TO AND SUBSCRIBED before me on this the _______ day of _____________________, _________. __________________________________ Notary Public My Commission Expires: _____________________ This Instrument was prepared by:                         Signature       Print or Type Name Request for Lien Information – Corporation Page 2 of 2