Fill and Sign the Subcontractors Affidavit of Warning Form

Subcontractor’ s Affidavit of Warning Page 1 of 1 SUBCONTRACTOR'S AFFIDAVIT OF WARNING --INDIVIDUAL I, ___________________________________ , am a supplier/subcontractor/or other person furnishing labor, equipment, material or supplies, used or consumed at the site of the property subject to the lien which is located at _____________________________________________________________________ . A warning statement was required to be given pur suant to K.S.A. 60 -1103a, and amendments thereto. I am hereby attaching to this Lien Statement this affidavit that such warning statement was properly provided to the owner, by personal service or by first class mail, postage prepaid, on the _____ day of ________________ , 20 ______ . This the _____ day of ______________ , 20 ______ . ______________________________ Signature _____ _____________________ ____ Type or Print Name I, _______________________________, do hereby swear or affirm that the matters alleged and things contained in the above Subcontractor's Affidavit of Warning are true and correct to the best of my knowledge, information, and belief. ________________________ Affiant Acknowledgment of Individual STATE OF KANSAS COUNTY OF ___________________ This instrument was acknowledged to me on _______________________________ (date) by ________________________________ [name(s) of person(s)]. ______________________________ Notary Public ______ ________________________ Type or Print Name ______________________________ Title (and Rank) (Seal, if any) My appointment expires: ___________________ KS § 60 -1103(a)(2)