Fill and Sign the Affidavit of Notice Corporation Llc Etc Form

Affidavit of Notice Page 1 of 2Prepared by, recording requested by and return to:Name: ________________________Company: _____________________Address: _____________________City: ________________________State: ______Zip: __________Phone: _____________________Fax: ________________________----------------------Above this Line for Official Use Only--------------------- Affidavit of Notice-Corporation, LLC, etc. (A.C.A. § 18-44-117) COMES NOW _________________________________, as representative of _________________________________ a _________________________________ company, and hereby would provide notice of the following: 1.The undersigned corporation has provided labor and/or materials for the improvement of the property located at and described as: __________________________________.2.After allowing for all credits, the undersigned is due the amount of $____________________ for said labor and/or materials. 3.This notice is filed within one hundred and twenty (120) days of the date labor and/or materials were provided. 4. Further, the undersigned hereby makes a sworn statement that the undersigned has complied with the notice provisions of Arkansas Code Annotated § 18-44-114 through § 18-44-116 and is attaching a copy of each notice given under Arkansas Code Annotated § 18-44-114 through § 18-44-116 to this Affidavit of Notice. Affidavit of Notice Page 2 of 2This the _____ day of _________________ , 20______.____________________________________Name of CompanyBy: _________________________________ _____ Signature Title ____________________________________Type or Print NameAttest: Secretary STATE OF ARKANSAS COUNTY OF _______________ On this the ____ day of ______________, 20__, before me, ____________________________________, the undersigned officer, personally appeared ____________________________________, who acknowledged himself to be the ____________________________________ of ____________________________________, a __________________ corporation or _______________________, and that he, being authorized so to do, executed the foregoing instrument for the purposes therein contained, by signing the name of the corporation by him/herself as ____________________________________. In witness whereof I hereunto set my hand and official seal on this ____ day of ______, 20___. ___________________________ NOTARY PUBLIC My Commission Expires:____________________ AR § 18-44-117(a)