Fill and Sign the Written Request for Copy of Notice of Commencement Corporation Form

Written Request for Copy of Notice of Commencement Page 1 of 2 WRITTEN REQUEST FOR COPY OF NOTICE OF COMMENCEMENT - CORPORATION STATE OF GEORGIACOUNTY OF ____________________The undersigned ___________________________________, as subcontractor, materialman, or other person, hereby requests that you as contractor provide a copy of the Notice of Commencement of the improvement of real property described as ______________________________________________________________________________ to the undersigned within ten (10) calendar days of receipt of this written request. Failure to give a copy of the Notice of Commencement within ten (10) calendar days of receipt of this written request shall render O.C.G.A. Section 44-14-361.5 inapplicable to the undersigned person making the request.WITNESS my signature on this the _____ day of ____________________, 20_____. ____________________________________ SignaturePrint Name: _________________________ Title: _______________________________Name of Corporation: _________________ Sworn to and executedin the presence of:__________________________ WitnessSworn to (or affirmed) and subscribed before me this ____ day of __________ (month), __________ (year), by _______________________ (name of person making statement)._______ Personally Known_______ Produced IdentificationType and # of ID __________________________ ____________________________(Signature of Notary) (Seal)_____________________________ Written Request for Copy of Notice of Commencement Page 2 of 2 (Name of Notary Typed, Stamped or Printed) Notary Public, State of GeorgiaMy Commission Expires: ______________ Reference44-14-361.5(b).Notes:The contractor shall be required to give a copy of the Notice of Commencement to any subcontractor, materialman, or person who makes a written request of the contractor. Failure to give a copy of the Notice of Commencement within ten calendar days of receipt of the written request from the subcontractor, materialman, or person shallrender the provision of this Code section inapplicable to the subcontractor, materialman, or person making the request.