NOTICE OF NON-RESPONSIBILITY
RECORDING REQUESTED BY:
AND WHEN RECORDED MAIL TO:
(City, State & Zip)
SPACE ABOVE THIS LINE FOR RECORDER'S USE
1NOTICE IS HEREBY GIVEN THAT:
1. The undersigned is 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
5. The full names and full addresses of all co-owners,
if any, who hold any title or interest with the undersigned in the property are
6. The name of the purchaser under contract, if any,
7. The name of the lessee, if any, is
8. The undersigned will not be responsible for any
claims arising from the work of improvement on the herein described property.
9. The street address of said property is _____________________________________
10. The property subject to the said work of
improvement is in the City of __________
County of __________________ State of
____________________, and is described as follows:
I, undersigned, say:
I am _______________ the ___________________
(President, Agent, etc.) owner of the aforesaid interest or estate in the
property described in the above notice; I have read the foregoing notice and
know and understand the contents thereof, and the facts stated herein are true
I declare under penalty of perjury that the
foregoing is true and correct.
Executed on _______________ (month & day), _____
(year), at _________________, (city), ______________________ (state).