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

WRITTEN REQUEST FOR COPY OF NOTICE OF COMMENCEMENT - INDIVIDUAL STATE OF GEORGIA COUNTY 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 _____ . ____________________________________ Signature Print Name: _____ ____________________ Sworn to and executed in the presence of: __________________________ Witness Sworn to (or affirmed) and subscribed before me this ____ day of __________ (month), __________ (year), by _______________________ (name of person making statement). _______ Personally Known _______ Produced Identification Type and # of ID __________________________ ____________________________ (Signature of Notary) (Seal) _____________________________ Written Request for Copy of Notice of Commencement Page 1 of 2 (Name of Notary Typed, Stamped or Printed) Notary Public, State of Georgia My Commission Expires: ______________ Reference 44 - 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 shall render the provision of this Code section inapplicable to the subcontractor, materialman, or person making the request. Written Request for Copy of Notice of Commencement Page 2 of 2