Fill and Sign the Request for Notice of Commencement Individual Ohio Form

REQUEST FOR NOTICE OF COMMENCEMENT - INDIVIDUAL (Ohio Revised Code Section 1311.04(D), (E) and (F)) State of Ohio County of __________________ _________________________________ , whose address is _______________________________________________________________________ , being first duly sworn, states: That pursuant to Ohio Revised Code §1311.04(D),(E),and (F)) the undersigned subcontractor, material supplier, or laborer does hereby request that the owner, part- owner, or lessee of the property being improved at ________________________________________________________________ or the contractor conducting improvements at that address, or any subcontractor conducting improvements at that address, within the next ten (10) days provide the undersigned subcontractor, material supplier, or laborer with a copy of the Notice of Commencement filed by the owner, part-owner, or lessee. THIS the _____ day of _____________ , 20 ______ . By: ___________________________________ Type or Print Name: _____ ______________________________ Witness: __________________________________ Witness: __________________________________ Request for Notice of Commencement Page 1 of 2 Acknowledgment of Individual STATE OF OHIO COUNTY OF _____________________ The foregoing instrument was acknowledged before me this _____________________ (date) by _________________________________________ (name of person acknowledged.) ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________ ACKNOWLEDGED, SWORN TO AND SUBSCRIBED before me on this the _______ day of _____________________, _________. ____________________________________ Notary Public My Commission Expires: ________________ This Instrument was prepared by:                         Signature       Print or Type Name Request for Notice of Commencement Page 2 of 2