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Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ________________________ Company: _____________________ Address: _____________________ City: ________________________ State: ______ Zip: __________ Phone: _____________________ Fax: ________________________ 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 1 of 2 This the _____ day of _________________ , 20 ______ . ____________________________________ Name of Company By: __________________________ ______ _ _____ Signature Title ____________________________________ Type or Print Name Attest: 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) Affidavit of Notice Page 2 of 2

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