_________
(Name of owner of record/Lessee)
_________
(Address of owner/Lessee)
NOTICE OF INTENTION TO DO WORK OR
FURNISH MATERIALS, OR BOTH
All persons are hereby notified that the undersigned has within the two hundred (200) days prior to the mailing hereof done work, furnished materials, or both, and/or intends to do so in the future (cross out inappropriate words), in the construction, erection, alteration, or preparation of an improvement on land described as follows: (here insert description) and that the land is owned by or leased to (here insert name of owner or lessee or tenant). The nature of the work being done or materials being furnished is as follows: (here insert general description of the nature of the work or materials, or both) and is being done for or furnished to (here insert name of person or persons for whom directly the work is being done or to whom directly the materials are being furnished), whose address is (here insert address).
The approximate value of said work or materials is, as of the date of the notice, $(include amount), itemized as follows: and the undersigned has not been paid for the work or materials or both;
The undersigned authorizes (here insert name or names) to act or sign documents in behalf of the undersigned in all matters pertaining to this notice, or any lien claimed hereunder, or release thereof.
You are hereby informed that the undersigned may within two hundred (200) days of the performance of the work or furnishing of the materials, file in the records of land evidence of the city or town of (here insert name of city or town) a copy of this notice of intention to do work or furnish materials. The filing of the notice of intention, together with this mailing, will perfect a lien against the land described herein, under and subject to the provisions of the Rhode Island Mechanics' Lien Law.
_____________________________________________________________________
_____________________________________________________________________
(Name and address of person
filing notice)
NOTARIZATION CLAUSE
_________
Signed and sworn before me this ______ day of ______,
_____________________________________________________________________
Notary Public
My Commission Expires:
R.I. Gen. Laws § 34-28-4