REQUESTED BY: ______________________
WHEN RECORDED MAIL TO:
1SPACE ABOVE THIS LINE
FOR RECORDER'S USE
Is Hereby Given That:
The undersigned is an owner or agent of an owner of the interest or estate
The full name of the owner is:
The full address of the owner is:
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 "Lessee").
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:
A work of improvement on the property hereinafter described was completed on
work done was: _________________.
The name of the contractor, if any, for such work of improvement is: __________
The street address of said property is:
The property on which said work of improvement was completed is in the City of
_________________________, County of ____________________, State of ______, and
is described as follows:
of Owner or Agent of Owner Named In Paragraph 2)
the undersigned, say:
am the ________________________________, 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.
declare under penalty of perjury that the foregoing is true and correct.
on ____________________, at ___________________________.