Partnership Lien Filing South Dakota Department of Transportation 1. Partnership Filing Lien: 2. DOT Project Number: County: AURORA BEADLE BENNETT BON HOMME BROOKINGS BROWN BRULE BUFFALO BUTTE CAMPBELL CHARLES MIX CLARK CLAY CODINGTON CORSON CUSTER DAVISON DAY DEUEL DEWEY DOUGLAS EDMUNDS FALL RIVER FAULK GRANT GREGORY HAAKON HAMLIN HAND HANSON HARDING HUGHES HUTCHINSON HYDE JACKSON JERAULD JONES KINGSBURY LAKE LAWRENCE LINCOLN LYMAN MARSHALL MCCOOK MCPHERSON MEADE MELLETTE MINER MINNEHAHA MOODY OGLALA LAKOTA PENNINGTON PERKINS POTTER ROBERTS SANBORN SPINK STANLEY SULLY TODD TRIPP TURNER UNION WALWORTH YANKTON ZIEBACH 3. Prime Contractor: 4. Subcontractor (if you are a second-tier sub or supplier): 5. Type of Work Performed: 6. Materials Supplied: 7: Dates Work Performed: 8. Balance Due: $ 9. Signature: ________________________________ 10. Title: Partner 11. Date: ________________________________
On this the ____ day of ____________ , 20___ , before me, __________________________________ , a notary public, personally appeared __________________________________, who acknowledged himself/herself to be one of the partners of _____________________________________________, a partnership, and that he/she, as such partner, being authorized so to do, executed the foregoing instrument for the purposes therein contained, by signing the name of the partnership by himself/herself as a partner. In witness whereof I hereunto set my hand and official seal. Signature of Notary Public:________________________________ State of:________________________________ (Notary Seal) Residing at:________________________________ My commission expires:________________________________
Instructions for a Partnership Filing a Lien Partnership requesting a lien. DOT project number: The South Dakota Department of Transportation (DOT) project number [such as BRO 8042(2)] of the project for which you are owed money. Complete a separate lien filing form for each project that you are owed money. County: The county or counties the project is located in. Prime contractor: self-explanatory. Provide name of subcontractor only if your company worked under that firm as a second-tier subcontractor or supplier. Provide a brief description of work your partnership provided, but was not paid, such as -- hauled 50 tons of gravel from crusher to project; seeded 10 acres; installed 150 ft of three cable guard rail. Materials supplied: Provide a list of materials you supplied by type and quantity or weight. Provide a list of the dates your partnership performed the work or supplied materials your partnership was not paid for. Provide the balance of the money due to your partnership for services or materials provided. Signature of one of the partners. Title: Partner Date the form was signed. The lien must be notarized. Retain a copy of the lien filing for your records. Liens are to be filed only for projects where payment is due from the DOT. The DOT does not have authority to file a lien on projects let by another department or governmental entity. This lien filing will withhold an amount of money sufficient to cover the lien from funds due or to become due to the prime contractor. Action to enforce or determine the validity of the lien may be brought by the claimant, the contractor, or the DOT in the Circuit Court for the county where the work or any part will be situated. This lien will cease to have any validity or be binding on the contractor or DOT unless an action to enforce the same is commenced within thirty (30) days from the acceptance of the work for which the same is claimed. Notwithstanding these instructions, the provisions of SDCL Chapter 5-22 govern liens relating to public improvement contracts. Mail original signed and notarized form to: Department of Transportation - Office of Legal Counsel 700 East Broadway Avenue Pierre, South Dakota 57501-2586