Fill and Sign the Arizona Notice Completion Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ___________________ Company: ___________________ Address: _____________________ City: _____________________ State: _____ Zip: ________ Phone: ______________________ Fax: _______________________ NOTICE OF COMPLETION—CORPORATION, LLC, etc. Notice is hereby given that: 1. The undersigned is owner of the interest or estate stated below in the property hereinafter described, or the undersigned is the owner's agent. 2. The full name of the undersigned is ______________________________________ . 3. The full address of the undersigned is ___________________________________ . 4. The nature of the interest or estate of the owner is: in fee. ___________________________________________ (If other than fee, strike "In Fee" and insert, for example, "Purchaser Under Contract of Purchase" or "Lessee".) 5. The full names and full addresses of all persons, if any, who hold interest or estate with the undersigned such as joint tenants or tenants in common are: Name Address __________________________________ __________________________________ __________________________________ Notice of Completion Page 1 of 4 6. The full names and full addresses of the predecessors in interest of the undersigned, if the property was transferred after the beginning of the work or improvement: Name Address __________________________________ __________________________________ __________________________________ 7. The nature of the improvements to the real property __________________________________ . 8. The work of improvement on the property hereinafter described was completed in accordance with the definition of completion in Arizona Revised Statutes section 33- 993, subsection C. (Fill in the appropriate completion date as defined in Arizona Revised Statutes section 33-993, subsection C .) (a) - Date _____________________________________ (thirty days after written final acceptance by governmental body) (b) - Date ____________________________________ (sixty days after cessation of labor) 9. The name of the original contractor, if any, for such work or improvement is ___________________________________ . (if no contractor, insert "none") 10. The street address of the property is _____________________________________ . (include both address and city with zip code) 11. The legal description of property described above _____________________________________ . (attach exhibit if necessary) Verification Notice of Completion Page 2 of 4 I, the undersigned, certify that I am the owner, the owner's agent for the property or another interested party in the property, described in the above Notice, or I certify that I am the original contractor of the improvements to the real property described in the above Notice. I have read the foregoing Notice and know and understand the contents thereof, and the facts stated therein are true and correct. I declare under penalty of perjury that the foregoing is true and correct. Executed on the _____ day of __________ , 20 ______ , at ____________________________________ , Arizona. (date) (place where signed) ______________________________ Name of Company By: __________________________ ___ _____ __ Signature Title ______________________________ Type or Print Name Attest: Secretary Acknowledgement State of Arizona County of ______________________________ The foregoing instrument was acknowledged and sworn to before me this _______________(date) by ______________________________ (name of officer or agent, title or officer or agent) of ______________________________ (name of corporation acknowledging) a _________________________(state or place of incorporation) corporation, on behalf of the corporation. ______________________________ NOTARY PUBLIC Print Name: _______________________ My Commission Expires: _____________________ Notice of Completion Page 3 of 4 In order to shorten the lien period pursuant to Arizona Revised Statutes section 33- 993, subsection A, a copy of the notice of completion and a written statement of the date of recording and the county recorder's record location information shall be served by certified or registered mail, postage prepaid, to the owner, the original contractor and all persons from whom the person recording this notice has previously received a preliminary twenty day notice as prescribed by Arizona Revised Statutes section 33-993, subsection I. Notice: Receipt of a notice of completion may alter the time you have to impress and secure a lien in accordance with Arizona Revised Statutes section 33-993, subsection A. AZ § 33-993(E) Notice of Completion Page 4 of 4