Fill and Sign the Ohio Notice Form 497322342

NOTICE OF PAYMENT - CORPORATION (Ohio Revised Code Section 1311.011(B)(8)(a)) State of Ohio County of _________________ Notice is hereby given that _______________________________ President of _________________________________ , a _______________________________ corporation, whose address is _______________________________________________________________________ , ___________________ , Ohio _______ , being first duly sworn, states: 1. That pursuant to Ohio Revised Code §1311.011(B)(8) the owner, part-owner, or lessee, or lending institution has withheld payment from original contractor, ___________________________________ , as a result of a dispute over payments due to subcontractor, material supplier, or laborer, __________________________________ . 2. That the above named corporate subcontractor, material supplier, or laborer, would hereby give notice pursuant to Ohio Revised Code §1311.011(B)(8)(a) that the amount of money claimed by him to be due has been paid. 3. Further, that there being no further dispute regarding payment between this subcontractor, material supplier, or laborer and the original contractor, that any amount withheld by the owner, part-owner, lessee, or lending institution may be paid to the original contractor without further delay. THIS the _____ day of _______________ , 20 ______ . By: ___________________________________ Type or Print Name: _____ ______________________________ Witness: __________________________________ Witness: __________________________________ Attest: Secretary Notice of Payment – Corporation Page 1 of 2 This instrument was prepared by __________________ (name). Acknowledgment of Corporation STATE OF OHIO COUNTY OF _____________________ The foregoing instrument was acknowledged before me this _____________________ (date) by __________________________________________ (name of officer or agent, title of officer or agent) of __________________________________________ (name of corporation acknowledging) a __________________________________________ (state or place of incorporation) corporation, on behalf of the corporation. 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 Notice of Payment – Corporation Page 2 of 2