Fill and Sign the Ok Address Form

REQUEST THAT CONTRACTOR PROVIDE LAST KNOWN ADDRESS OF OWNER- INDIVIDUAL (Okla. Stat. Ann. § 42-142.6-B.6) COMES NOW, _________________________________ , as claimant who is entitled to lien rights for the supply of materials, services, labor or equipment for improvements to property located at and/or legally described as _______________________________________________________________________ , and hereby requests that you as original contractor provide to the undersigned the name and last-known address of the owner of the above-described property. If you f ail to provide the undersigned with the information requested within five (5) days from the date of receipt of this Request, the pre-lien notice requirement to the owner of the property will be rendered unenforceable. This the _____ day of ______________ , 20 ______ . __________________________________ Signature _____ _____________________________ Type or Print Name STATE OF OKLAHOMA COUNTY OF __________________ Subscribed and sworn before me, the undersigned, a Notary Public, in and for said County and State, this the __________ day of _________________, 20___, ___________________________ Notary Public Print Name: _________________ My commission expires: _____________________ CERTIFICATE OF SERVICE I,       (name), certify that I am , and at all times during the service of process was, not less than 18 years of age and not a party to the matter concerning which service was made. I further certify that the service was made       (date) by: Request that Contractor Provide Last Known Address of Owner Page 1 of 2 Certified Mail, return receipt requested: Hand Delivery by the United States Postal Service supported by a delivery confirmation receipt; or By automated transaction pursuant to Section 15-115 of Title 12A of the Oklahoma Statutes. Under penalty of perjury, I declare the foregoing is true and correct. Date:       Signature Print Name:       Business Address:       City:       State:       Zip:       Request that Contractor Provide Last Known Address of Owner Page 2 of 2