Notice Of Non Responsibilty

RECORDING REQUESTED BY: AND WHEN RECORDED MAIL TO: (NAME) (STREET ADDRESS) (CITY. STATE AND ZIP) SPACE ABOVE THIS LINE FOR RECORDER'S USE NOTICE OF NON-RESPONSIBILITY NOTICE 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: in fee 5. The full names and 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 said work of improvement is in the City of County of State of and is described as follows Date: (Verification for Individual Owner) (Signature of Owner or Corporate Officer of Owner) I, the undersigned, say: I am VERIFICATION the (President, Partner, 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 (DATE OF SIGNATURE) , 19 , at (CITY AND STATE WHERE EXECUTED) (SIGNATURE OF THE INDIVIDUAL WHO VERIFIES THAT THE CONTENTS OF THE CLAIM OF MECHANIC'S LIEN ARE TRUE) American LegalNet, Inc. www.FormsWorkFlow.com 2001 © American LegalNet, Inc.