Fill and Sign the West Virginia Form 497431624

PRELIMINARY NOTICE TO OWNER – INDIVIDUAL (W.Va. Code §38-2-20) COMES NOW, _________________________________ , as a laborer or other person employed to do work or furnish materials or machinery for the erection, construction, alteration, repair or removal of the building or other structure, or any improvement appurtenant thereto, on the property located at and described as ________________________________________________________________________ _______________________________________________________________________ , and would provide notice of the following: 1. The undersigned is providing this Notice before he or she begins doing any work, or furnishing any material or machinery for the improvement of the above-described property. 2. Notice is hereby provided that if the undersigned is not paid for said labor and/or materials by ________________________________ , the person who employed the undersigned, the undersigned will look to the owner for payment. 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