Fill and Sign the Sd Corporation 497326230 Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: _________________ Company: __________________ Address: ___________________ City: ________________ State: ______ Zip: _________ Phone: _______________ Fax: ________________ NOTICE OF FURNISHING OF LABOR OR MATERIALS – CORPORATION (S.D. Codified Laws Ann. § 44-9-53) TO CONTRACTOR: _____________________________________________________ (NAME/ADDRESS) AND OWNER: _______________________________________________________________ (NAME/ADDRESS) COMES NOW, ___________________________________ , as a representative of ___________________________________ a _________________________________ corporate sub-contractor, or corporate supplier to sub-contractors, which has furnished labor and/or materials for the improvement of the property located at and described as ________________________________________________________________________ ______________________________________________________________________ , and would provide notice of the following: 1. The undersigned actually furnished or is scheduled to furnish the first item of labor and/or materials on the _____ day of _____________ , 20 _______ , and ceased, or will cease, providing labor and/or materials for the improvement of the above described property on the _____ day of _____________ , 20 _______ . 2. The undersigned contracted with or was employed by ______________________ . 3. A description of the labor, services, or materials furnished and the contract price or value thereof is as follows: labor/services/materials date cost/value ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ . Notice of Furnishing of Labor or Materials Page 1 of 3 4. A description of the project is as follows: _______________________________________________________________________ . 5. The undersigned is due the amount of $ _______________ . 6. A copy of this notice has been provided to the project’s principal contractor and to the property owner of record by certified or registered mail. Post office receipts evidencing said mailings are attached hereto. This the _____ day of _____________ , 20 ______ . ________________________ Signature _____ ___________________ Type or Print Name _____ ___________________ Title _____ ___________________ Corporation Attest: Secretary State of South Dakota County of __________________ On this , the ______ day of ____________ , 20 ______ , before me, ______________________________ , the undersigned officer, personally appeared ______________________________ , who acknowledged himself to be the ____________ of ________________________ , a corporation, and that he/she, as such ________________________ being authorized so to do, executed the foregoing instrument for the purposes therein contained, by signing the name of the corporation by himself/herself as __________________ . In witness whereof I hereunto set my hand and official seal. Notary Public, State of ____________ My commission expires:       Type or Print Name Notice of Furnishing of Labor or Materials Page 2 of 3 Certificate of Delivery I, ____________________________________ , hereby certify that I have delivered this day a true and correct copy of the foregoing to ____________________________________ by mailing a true and correct copy of same by certified or registered U.S. mail, postage prepaid, return receipt requested. So certified this the _____ day of _____________ , 20 _______ . ________________________ Signature Notice of Furnishing of Labor or Materials Page 3 of 3