This Mechanic's Lien form is for use by an individual who has provided labor and/or materials for the improvement of real property to file a mechanic's lien and state the name of the person with whom the individual contracted or who requested the individual to provide such labor and/or materials, the name of the owner or reputed owner, if known, of the property, the amount the individual is owed for such labor and/or materials and that demand for payment has been made.