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M.G.L. c. 254 §4

Notice is hereby given to _________________, as contractor, that ________________,

as subcontractor/vendor, has entered into a written contract with _________________ to furnish

labor or materials, or labor and materials, or rental equipment, appliances or tools to a certain

construction project located at ________________ (Street Address), ____________________

(Town or City), Massachusetts. The amount or estimated amount of said contract is

$__________. (No amount need be stated for contracts for the rental of equipment, appliances or tools).

Subcontractor/Vendor: ______________________

By: __________________________

its: ___________________________


________________________, ss


Then personally appeared the above named ______________________ before me who after being duly sworn did acknowledge that his/her/ signature on the foregoing instrument is his/her free act and deed and that he/she is authorized to execute this document on behalf of the above-referenced Subcontractor or Vendor.


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