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Notice Of Completion

RECORDING REQUESTED BY:

AND WHEN RECORDED MAIL TO:

_____________________________

(Name)

_____________________________

(Street Address)

_____________________________

(City, State & Zip)

=================================================

SPACE ABOVE THIS LINE FOR RECORDER'S USE

Notice Is Hereby Given That:

1. The undersigned is an owner or agent of an owner of the interest or estate stated below.

2. The full name of the owner is: _____________________________

3. The full address of the owner is: ____________________________

4. The nature of the interest or estate of the owner is; in fee.

(If other than fee, strike "in fee" and insert, for example, "Purchaser Under Contract of Purchase," or "Leasee")

5. The full names and full addresses of all co-owners, if any, who hold any title or interest with the above-named owner in the property are:

NAME

ADDRESSES

6. A work of improvement on the property hereinafter described was completed on ________________. The work done was: (Date)

7. The name of the contractor, if any, for such work of improvement is _________________ (If no Contractor for work of improvement, insert "none")

8. The street address of said property is: ____________________________ (If no street address has been assigned, insert none")

9. The property on which said work of improvement was completed is in the city of ________ County of _______, State of ______, and is described as follows:

DATE: ________________.

(Verification for individual owner)

___________________________________

(Signature of owner or agent of owner named in Paragraph 2)

VERIFICATION

I, undersigned, say:

I am the _____________ ("President," "Partner," etc.) the declarant of the foregoing notice of completion; I have read said Notice of Completion and know the contents thereof; the same is true of my own knowledge.

I declare under penalty of perjury that the foregoing is true and correct.

Executed on _______________, 20 __, at _____________________,

(Date of signature)

(City where signed)

(State where signed)

(Personal signature of the individual who is swearing that the contents of the notice of completion are true)