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Fill and Sign the South Dakota Form 497326119

Fill and Sign the South Dakota Form 497326119

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Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: _____________________ Company: ___________________ Address: ______________________ City: _______________ State: ______ Zip: _________ Phone: _________________ Fax: ________________ Statement of Contract – Individual (S.D. Codified Laws Ann. §44-9-8) COMES NOW, __________________________________ , as a party having a contract for the furnishing of labor, skill, material, or machinery for the improvement of the property located at and described as _____________________________________________________________ _____________________________________________________________ , and would provide notice of the following: 1. The undersigned entered into a contract to provide labor, skill, material, or machinery, for the improvement of said property with __________________________________ on or about the _____ day of _______________ , 20 ______ . 2. A brief statement of the terms of said contract are as follows: _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ . Statement of Contract Page 1 of 2 3. Pursuant to South Dakota Codified Laws Annotated § 44-9-8 this statement shall serve as notice of the undersigned’s lien for the contract price or value of all contributions to said improvement thereafter made by the undersigned or at the undersigned’s instance. This the _____ day of _______________ , 20 _______ . _________________________ Signature _____ ____________________ Type or Print Name State of South Dakota County of __________________ On this ______ day of __________________ , 20 ______ , before me, ______________________________ , the undersigned officer, personally appeared ______________________________ , known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument and acknowledged that he/she executed the same for the purposes therein contained. In witness whereof I hereunto set my hand and official seal. Notary Public, State of       My commission expires:       Type or Print Name Statement of Contract Page 2 of 2

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