NOTICE OF NON-RESPONSIBILITY
RECORDING REQUESTED BY:
______________________________
AND WHEN RECORDED MAIL TO:
______________________________
(Name)
______________________________
(Street Address)
______________________________
(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
is ___________________________
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,
is __________________________
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:
______________________________________________________________
_____________________________________________________________________
VERIFICATION
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
and correct.
I declare under penalty of perjury that the
foregoing is true and correct.
Executed on _______________ (month & day), _____
(year), at _________________, (city), ______________________ (state).
