Fill and Sign the Owners 10 Day Notice to Contractor of Intent to Pay Lienors Individual Form

Owner’s 10 Day Notice to Contractor Page 1 of 2 OWNER’S 10-DAY NOTICE TO CONTRACTOR OF INTENT TO PAY LIENORS- INDIVIDUAL TO: ___________________________________ DATE: __________________________________ __________________________________ __________________________________ (contractor's name and address)The undersigned hereby informs you with ten days’ notice and before he or she pays any money directly to any lienor except the contractor or any laborer, that he or she intends to make payments directly to the following lienors in the following amounts: Name/Address of Lienor _________________________________________________________Amount to be Paid ____________________________Name/Address of Lienor ________________________________________________________Amount to be Paid _____________________________Name/Address of Lienor _________________________________________________________Amount to be Paid ____________________________Name/Address of Lienor ________________________________________________________Amount to be Paid _____________________________ __________________________________ (Owner’s signature) Type or Print Name: _____________________________ Address: ______________________________________ Certificate of Service I, _____________________________________, hereby certify that I have delivered this day a true and attested copy of the foregoing to ___________________________________ by: ( ) Actual Delivery to the person to be served. ( )Mailing a true and correct copy of same by registered or certified U.S. mail, with postage prepaid, or by overnight or second-day delivery with evidence of delivery. ( ) If service cannot be made by the above methods, by posting on the premises. ________________________ Owner’s 10 Day Notice to Contractor Page 2 of 2 Signature