TO:
.....
|
|
(Surety that issued payment bond) |
|
and
.....
|
|
(The contractor on whose behalf the bond was issued) |
|
NOTICE IS HEREBY GIVEN that the undersigned claimant has a claim against the above named surety for labor and materials furnished by the undersigned for the public work described as follows: ..... |
|
.....
|
|
(Description of the public work) |
|
The labor and materials were furnished under a contract or agreement with |
|
.....
|
|
(Name and address of contractor or supplier requesting labor and materials from the claimant) |
|
The nature of the labor and materials furnished is as follows: ..... |
|
.....
|
|
The amount of the claim is: ..... |
|
The date the claimant last furnished labor and materials to this public work is the ...... day of ......................., ............ |
|
Claimant seeks payment of the claim according to the law. |
.....
|
||
Claimant |
||
.....
|
||
Address |
||
.....
|
||
STATE OF
.....
|
||
ss. |
||
COUNTY OF
.....
|
||
................................. being duly sworn on oath says that ...... is ......................... of the claimant named above and has knowledge of the claim and that the claim is correct, and no part of the claim has been paid. |
||
.....
|
||
Signed and sworn to before me on
.....
,
.....
,
|
||
by
.....
|
(Notary Seal) |
|
.....
|
||
Notary Public |
Official Publication of the State of Minnesota
Revisor of Statutes