Fill and Sign the South Dakota Form 497326128

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 – Corporation (S.D. Codified Laws Ann. §44-9-8) COMES NOW, _________________________________ , as a representative of _________________________________ a _________________________________ corporation 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: _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ ____________________________________________________________ . 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. Statement of Contract Page 1 of 2 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 Statement of Contract Page 2 of 2