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Notice Of Non Responsibility
Recoding Requested By:
When recorded mail to:
(City / State / Zip)
Space above this line for recorder's use
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 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:
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 ______________,20 ___, at ___________(City), _________________