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Fill and Sign the One Hundred and Twentieth Day Nevada Legislature Form

Fill and Sign the One Hundred and Twentieth Day Nevada Legislature Form

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Prime Contractor’s Information Statement Page 1 of 1 PRIME CONTRACTOR’S INFORMATION STATEMENT- INDIVIDUAL (NRS § 52-143(1)) THE UNDERSIGNED prime contractor hereby states that he or she received a request for information from __________________________________, a claimant who may claim a lien through him or her under the Nebraska Construction Lien Act on _____________________ (date), and responds to the request within ten (10) days of receipt of such request, by stating the following:1) The real estate being improved is sufficiently identified and described as: __________________________________________________________________ ___________________________________________________________________________________________________________________________________.2) The undersigned contracted with the following contracting owner: ________________________________ whose address is: _________________________________________________________________. 3)There is or is not a surety bond, and the name of the surety (if applicable) is: ________________________________. This the _____ day of _____________ , 20______.__________________________________Signature of Lien Holder__________________________________Type or Print Name

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