Fill and Sign the Preliminary 20 Day Notice Form

PRELIMINARY TWENTY DAY NOTICE--INDIVIDUAL TO: Owner name and Address ___________________________________ ___________________________________ ___________________________________ Contractor Name and Address ___________________________________ ___________________________________ ___________________________________ Lender Name and Address ___________________________________ ___________________________________ ___________________________________ Supplier Name and Address ___________________________________ ___________________________________ ___________________________________ In accordance with Arizona Revised Statutes section 33-992.01, this is not a lien. This is not a reflection on the integrity of any contractor or subcontractor. This is a preliminary notice. The name and address of the owner or reputed owner is (Name, address and zip): _________________________________________ This preliminary lien notice has been completed by (name and address of Claimant): __________________________________ The name and address of the original contractor is (Name, address and zip): ______________________________________ You are hereby notified that the claimant has furnished or will furnish labor, professional services, materials, machinery, fixtures or tools of the following general description: ____________________________________ The name and address of any lender or reputed lender and/or assigns is (name, address, zip): ______________________________________ In the construction, alteration or repair of the building, structure or improvement at: ____________________________________ The name and address of the person with whom the claimant has a contract is (name, address, zip): ___________________________________ And situated upon that certain lot(s) of land in __________________________________ County, Arizona described as follows: _____________________________________ An estimate of the total price of the labor, professional services, materials, machinery, fixtures or tools furnished or to be furnished is: __________________________________ Preliminary Twenty Day Notice Page 1 of 4 NOTICE TO PROPERTY OWNER IF BILLS ARE NOT PAID IN FULL FOR THE LABOR, PROFESSIONAL SERVICES, MATERIALS, MACHINERY, FIXTURES OR TOOLS FURNISHED, OR TO BE FURNISHED, A MECHANIC'S LIEN LEADING TO THE LOSS, THROUGH COURT FORECLOSURE PROCEEDINGS, OF ALL OR PART OF YOUR PROPERTY BEING IMPROVED MAY BE PLACED AGAINST THE PROPERTY. YOU MAY WISH TO PROTECT YOURSELF AGAINST THIS CONSEQUENCE BY EITHER: 1. REQUIRING YOUR CONTRACTOR TO FURNISH A CONDITIONAL WAIVER AND RELEASE PURSUANT TO ARIZONA REVISED STATUTES SECTION 33-1008, SUBSECTION D, PARAGRAPHS 1 AND 3 SIGNED BY THE PERSON OR FIRM GIVING YOU THIS NOTICE BEFORE YOU MAKE PAYMENT TO YOUR CONTRACTOR. 2. REQUIRING YOUR CONTRACTOR TO FURNISH AN UNCONDITIONAL WAIVER AND RELEASE PURSUANT TO ARIZONA REVISED STATUTES SECTION 33-1008, SUBSECTION D, PARAGRAPHS 2 AND 4 SIGNED BY THE PERSON OR FIRM GIVING YOU THIS NOTICE AFTER YOU MAKE PAYMENT TO YOUR CONTRACTOR. 3. USING ANY OTHER METHOD OR DEVICE THAT IS APPROPRIATE UNDER THE CIRCUMSTANCES. WITHIN TEN DAYS OF THE RECEIPT OF THIS PRELIMINARY TWENTY DAY NOTICE THE OWNER OR OTHER INTERESTED PARTY IS REQUIRED TO FURNISH ALL INFORMATION NECESSARY TO CORRECT ANY INACCURACIES IN THE NOTICE PURSUANT TO ARIZONA REVISED STATUTES SECTION 33-992.01, SUBSECTION I OR LOSE AS A DEFENSE ANY INACCURACY OF THAT INFORMATION. WITHIN TEN DAYS OF THE RECEIPT OF THIS PRELIMINARY TWENTY DAY NOTICE IF ANY PAYMENT BOND HAS BEEN RECORDED IN COMPLIANCE WITH ARIZONA REVISED STATUTES SECTION 33-1003, THE OWNER MUST PROVIDE A COPY OF THE PAYMENT BOND INCLUDING THE NAME AND ADDRESS OF THE SURETY COMPANY AND BONDING AGENT PROVIDING THE PAYMENT BOND TO THE PERSON WHO HAS GIVEN THE PRELIMINARY TWENTY DAY NOTICE. IN THE EVENT THAT THE OWNER OR OTHER INTERESTED PARTY FAILS TO PROVIDE THE BOND INFORMATION WITHIN THAT TEN DAY PERIOD, THE CLAIMANT SHALL RETAIN LIEN RIGHTS TO THE EXTENT PRECLUDED OR PREJUDICED FROM ASSERTING A CLAIM AGAINST THE BOND AS A RESULT OF NOT TIMELY RECEIVING THE BOND INFORMATION. THIS Notice dated this the _____ day of __________________ , 20 _____ . _________________________________ Signature _____ ____________________________ Print or Type Name Preliminary Twenty Day Notice Page 2 of 4 _____________________________________________________________________ ACKNOWLEDGMENT OF RECEIPT OF PRELIMINARY 20 DAY LIEN NOTICE ________________________________________________________________________ Sender: ________________________________________________(Name and signature) This acknowledges receipt on ______________________________________, of a copy of the Preliminary 20 day Notice given by ____________________________________, for labor, materials or machinery furnished at the jobsite known as __________________________________________________________________________________________ _____________________________________________________. Dated : ____________________________ _________________________________________ Signature of person acknowledging receipt ______________________________ Title Notice: To comply with A.R.S. 33-992.02, you are required to sign and return this acknowledgment of service to the address below within 30 days of receipt: ________________________ ________________________ ________________________ ________________________ Preliminary Twenty Day Notice Page 3 of 4 Certificate of Mailing I, _____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing Preliminary Twenty Day Notice and Acknowledgment of Receipt to (provide name and address of all persons): ___________________________________ ___________________________________ ___________________________________ ___________________________________ by: ( ) First Class Mail with a Certificate of Mailing. ( ) Certified, registered U.S. mail postage prepaid, return receipt requested.. So certified this the ______ day of ___________________, 20____. ____________________________________ Signature AZ § 33.992.01 Preliminary Twenty Day Notice Page 4 of 4