Fill and Sign the Substantial Completion 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 SUBSTANTIAL COMPLETION--INDIVIDUAL (Mass. Gen. Laws Ann. ch. 254 § 2A) Notice is hereby given that the work performed by virtue of a written contract dated the ______ day of ______________ , 20 ______ , between ______________________________ as Owner, and _____________________________ as Contractor, for the erection, alteration, repair or removal of a building, structure, or other improvement of real property described below, has been substantially completed as of the date of filing or recording of this notice. The lot of land or other interest in real property which is the subject of such contract is described as follows: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________ [Legal Description of Property] The undersigned Owner hereby states that he has served written notice of the recording or filing of this notice of substantial completion upon every person who has filed or recorded prior to the date this notice is filed or recorded notice of contract under section four of chapter two hundred and fifty-four of the General Laws. The undersigned Contractor hereby states that he has served written notice of the recording or filing of this Notice of Substantial Completion upon every person who has entered into a written contract directly with the contractor or who has given written notice of identification to the contractor prior to the date this notice is filed or recorded as provided in said section four of said chapter two hundred and fifty-four of the General Laws. This the _____ day of ________________ , 20 ______ . ________________________ ________________________ Owner Contractor _____ __________________ _____ ___________________ Type or Print Name Type or Print Name State of Massachusetts County _____________ On this _______ day of _________, 20 ___, before me the undersigned notary public, personally appeared ________________________________________ (name of document signer), proved to me through satisfactory evidence of identification, which were _________________________________, to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he or she signed it voluntarily for its stated purpose. _____________________ Notary Public Print Name: ___________________ My commission expires: ____________________ Certificate of Delivery I, _____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing Notice of Substantial Completion, as recorded and filed, to ___________________________________ by mailing a true and correct copy of same by certified mail, return receipt requested , U.S. mail, postage prepaid to ___________________________, at his/her usual place of business located at ______________________________________. So certified this the ______ day of ___________________, 20____. ______________________________ Signature MA Ch. 254 § 2A