Fill and Sign the Pa File Claim Online Form

Formal Notice of Intention to File Claim Page 1 of 2 Formal Notice of Intention to File Claim -- Corporation (Pa. Stat. Ann. tit 49, § 1501(b)) COMES NOW, __________________________________, as a representative of ________________________________ a ________________________________ corporation which has provided labor and/or materials for the alteration, repair, erection, or construction of the property located at and described as _______________________________________________________________________, and would state as follows: 1. On or about the day of ______________ , 20 , the undersigned subcontractor began providing labor and/or materials under an agreement with the improvement’s primary contractor, _________________________________. 2.The undersigned is entitled to the value of said labor and/or materials provided, to wit:Labor/Materials FurnishedDate FurnishedValue/Cost________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________. 3.The amount due the undersigned is $ ______________. 4. The undersigned ceased furnishing labor and/or materials on the day of _____________, 20 ______. This the day of _______________, 20 ______ . _________________________________Signature_________________________________Type or Print Name ____________________________Title ____________________________Corporation Formal Notice of Intention to File Claim Page 2 of 2 Certificate of Delivery I, ________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing to __________________________________ by:Personal Service Mailing a true and correct copy of same by first class registered or certified U.S. mail, postage prepaid, return receipt requested to ___________________________________. So certified this the _____ day of _______________, 20_______. ________________________Signature