Fill and Sign the Texas Claimant Form

REQUEST TO CLAIMANT FOR DOCUMENTS REFLECTING CLAIM - INDIVIDUAL The undersigned individual, ________________________________ , as the owner, the contractor under whom a bond is made, or a surety on a bond on which a claim is made, hereby requests that ________________________________ , as claimant for a lien under the bond furnish to the undersigned a copy of any applicable written agreement, purchase order, or contract and any billing, statement or payment request of the claimant reflecting the amount claimed and the work performed by the claimant for which the claim is made. (Optional: Please also provide the estimated amount due for each calendar month in which the claimant has performed labor or furnished materials). Signed on the _____ day of _______________ , 20 _____ . Signature       Printed Name Certificate of Delivery I,       , hereby certify that I have delivered this day a true and correct copy of the foregoing to       by: Hand Delivery. Mailing a true and correct copy of same by Certified or Registered U.S. Mail, postage prepaid, to       , at his/her last known business or residence address located at       . So certified this the _____ day of _______________ , 20 _____ . Signature TX Code § 53.159(d) Request to Claimant for Documents Reflecting Claim Page 1 of 1