Fill and Sign the West Virginia Form 497431628

PRELIMINARY NOTICE TO OWNER – CORPORATION (W.Va. Code §38-2-20) COMES NOW, _________________________________ , as a laborer or other entity employed to do work or furnish materials or machinery for the erection, construction, alteration, repair or removal of a 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 the undersigned 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 _____ ____________________ Title _____ ____________________ Corporation 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