OWNER’S WRITTEN NOTICE OF LIEN RELEASE BOND
[Business Entity as Owner]
To: Lien Claimant:
Street Address:
City, State and Zip Code:
Name of owner giving notice:
Street Address:
City, State and Zip Code:
Relationship to other parties:
Name of direct contractor:
Street Address:
City, State and Zip Code:
Name of construction lender:
Street Address:
City, State and Zip Code:
Site of the Improvement:
Street Address:
City, State and Zip Code:
Legal Description:
COMES NOW, , and would provide notice of
the following:
1. On or about , 20 , a lien was claimed against the above
described property by
.
2. On or about , 20 , a Stop Payment Notice was received
by the undersigned from
.
Owner’s Written Notice of Lien Release Bond Page 1 of 3
CA Civil Code § 8522
3. On or about , 20 the undersigned recorded in the office
of the county recorder in which said lien was claim of lien was recorded, a bond executed
by a corporation authorized to issue surety bonds in the State of California, in the amount
of $ .
4. Pursuant to California Civil Code § 8522(b), a copy of said bond is attached to this
notice.
Date:
Name of Entity:
ATTESTED BY: (if required) A Corporation
By:
Signature Signature of authorized signatory
Type or Print Name Type or Print Name
Its:
Position or Rank Capacity of Signatory
Owner’s Written Notice of Lien Release Bond Page 2 of 3
CA Civil Code § 8522
PROOF OF NOTICE DECLARATION
(Civil Code § 8118)
I, , declare that I have served copies of the
OWNER’S WRITTEN NOTICE OF LIEN RELEASE BOND by (check appropriate box below):
a. By personally delivering copies to:
Name:
Title:
At: Street Address:
City, State and Zip Code:
On: , 20 , at am / pm.
b. By Certified, Express, or Registered Mail Service, postage prepaid addressed to:
Name:
Title:
At: Street Address:
City, State and Zip Code:
On: , 20 , at am / pm.
See attached documentation provided by the US Postal Service or express mail service showing
the date of delivery and the name of the person accepting delivery; tracking record or other
documentation from express carrier showing attempted delivery or delivery of the notice; or, in
the event of non-delivery, the returned envelope itself.
I declare under penalty of perjury that the foregoing is true and correct.
Signed at , California , on , 20 ______
.
Signature
Print or Type Name
ATTACH SERVICE LIST OF CERTIFIED OR REGISTERED MAIL WHEN
RETURNED, OR PHOTOCOPY OF POST OFFICE RECORD OF DELIVERY OF
RECEIPT.
A notary public or other officer completing the certificate verifies only the identity of the
individual who signed the document to which this certificate is attached, and not the
truthfulness, accuracy, or validity of that document.
State of California
County of ______________________
On ______________________ before me, ______________________ (here insert name and title of
the officer), personally appeared ______________________ , who proved to me on the basis of
Owner’s Written Notice of Lien Release Bond Page 3 of 3
CA Civil Code § 8522
satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and
that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the
person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
Witness my hand and official seal.
_____________________________________________
Signature
(Seal)
Owner’s Written Notice of Lien Release Bond Page 4 of 3
CA Civil Code § 8522
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