Fill and Sign the West Virginia Account Form

DEMAND FOR ACCOUNT BY OWNER – INDIVIDUAL (W.Va. Code §38-2-19) To: _________________________________ COMES NOW, ________________________________ , as the owner of the property undergoing improvement located at and described as ________________________________________________________________________ _______________________________________________________________________ , and would state as follows: 1. Pursuant to W.Va. Code §38-2-19 the undersigned property owner hereby demands that _______________________________ , as a subcontractor, laborer, mechanic, workman or party furnishing labor and/or materials for the improvement of the above-described property, provide, within fifteen (10) days of receipt of this notice, an itemized account of the following: A. All work done or caused to be done, or of the materials or other equipment furnished for such work, B. The dates upon which said work was done or materials furnished, C. The price charged therefore, and D. The nature of said work or materials. 2. NOTICE: The neglect or failure of any such laborer, mechanic or other person furnishing materials, machinery or other necessary equipment for the doing of the same, so to file such itemized statement with such owner, within ten days after the receipt by him or her of such written notice so to do, shall release such owner from all responsibility and his or her property from all lien or charge for all labor done and for all materials furnished by the person so failing to file such required itemized statement, prior to the giving of such notice. This the _____ day of _______________ , 20 ______ . __________________________ Signature _____ _____________________ Type or Print Name Certificate of Delivery I, ___________________________________ , hereby certify that I have delivered this day a true and correct copy of the foregoing to __________________________________ by: ( ) Personal Service ( ) Mailing a true and correct copy of same by certified or registered U.S. mail, postage prepaid, return receipt requested. So certified this the _____ day of ________________ , 20 ______ . ________________________ Signature