Fill and Sign the Wi Lien Form 497430568

      Document Number       Document Title Recording Area Name and Return Address                         Parcel Identification Number (PIN) PRIME CONTRACTOR 1 CLAIM FOR LIEN- CORPORATION §779.06, Wis. Stats. NOTE: This Claim for Lien must be docketed with the Clerk of Courts in the County where the Property is located. A copy of this claim must be served on the Owner of the property within thirty (30) days after filing the claim. Date:       To the Clerk of Circuit Court for       County, State of Wisconsin: 1. Claimant's Name:       Claimant's Address:                   Claimant is a corporation limited liability company partnership sole proprietorship individual assignee other:       1 A Prime Contractor is anyone who performs, furnishes, or procures labor, services, materials, plans, or specifications for construction under a contract directly with the Owner of the property being improved, and as provided in §779.01(2)(d), Wis. Stats. (specify) 2. Owner(s) Name(s):       Owner Address:                   3. Legal Description of Owner's Property improved by Claimant is:  attached to this Claim for Lien  described as:                   located in       County, Wisconsin, and more commonly known as:       (street address) 4. Description of labor, services, materials, plans or specifications performed, furnished or procured by Claimant to improve Owner's Property:             under a written contract dated:       other (specify):       5. Date of first visible commencement of the entire work of improvement on the Property (whether by Claimant or others):       6. Date Claimant first furnished labor or materials:       7. Date Claimant last furnished labor or materials:       8. Prime Contractor’ Notice of Lien Rights was (check as applicable):  Given to Owner as part of the Claimant’s written contract for construction with the Owner.  Given to the Owner by registered mail or hand delivery within ten (10) days after first furnishing labor and materials under an oral contract.  Not given to Owner because (check one):  No subcontractor or material suppliers worked for Claimant in improving the Owner’s property.  This was residential construction of more than a four-family building.  This was non-residential construction.  Prime Contractor, or its officer(s) or controlling shareholder(s), hold(s) an interest in Owner's Property.  Prime Contractor is managed or controlled by a corporation or company which owns the Property.  Claimant has fully paid all its obligations to subcontractors and/or material suppliers for their work improving the Property AND the lien rights of all Claimant’s subcontractors and/or material suppliers have lapsed. 9. Date Claimant's Notice of Intention to File Claim for Lien was given to Owner (must be at least 30 days before the filing of this Claim for Lien):       10. The Total Amount owed to Claimant: $       Amount paid or otherwise satisfied to date: ($       ) AMOUNT CLAIMED: $       Statement of Claim Claimant makes and files this claim for a lien upon the interest held by the Owner in the Property under Chapter 779, Wis. Stats., not more than six (6) months after Claimant last furnished labor and/or materials as stated in Paragraph 7 above. Claimant certifies to the best of Claimant's knowledge and belief that all information contained in this Claim for Lien is correct. Based upon the above information, Claimant claims a lien upon all of the interest which the Owner has in the above described Property and improvements on it at the time of first visible commencement of the work of improvement, or that Owner may have acquired since that time, in the amount of Dollars       ($       ). This claim is subject to amendment in the event foreclosure action is commenced. Claimant's Name:       By: (signature) Authorized Agent's Name:       (print name of person signing above) Title:       Address:                   Telephone No:       The following must be attached to this Claim for Lien:  Legal Description (unless fully set forth in Paragraph 3 above)  Prime Contractor’s Notice of Lien Rights (unless not provided to Owner as indicated in Paragraph 8 above)  Notice of Intention to File Claim of Lien This instrument was drafted by _____________ . C E R T I F I C A T E O F S E R V I C E I, ________________________ , do hereby certify that on (date) a true and correct copy of the above and foregoing ________________________ was served upon ______________________________ by: Personal Service Mailing a copy of the above document by certified mail, return receipt requested, to ________________________ at the following address: ________________________ ________________________ Mailing a copy of the above document by registered mail, return receipt requested, to ________________________ at the following address: ________________________ ________________________ So certified this the ______ day of ___________________, 20____. Signature       Print/Type Name