Fill and Sign the Change O F Information Minnesota Department of Health

Notice of Lis Pendens Page 1 of 3Prepared by, recording requested by and return to:Name: _______________________Company: _____________________Address: ____________________City: _______________________State: _______Zip: _________Phone: _______________________Fax: ______________________----------------------Above this Line for Official Use Only--------------------- NOTICE OF LIS PENDENS - INDIVIDUAL (A.S. § 34.35.080(c)) COMES NOW, ___________________________________, and hereby gives notice of the pendency of an action affecting the title to or the right of possession of real property pursuant to Alaska Statutes § 34.35.080(c) and § 09.45.940 and provides the following: 1. A civil action has been commenced in _____________________________________ Court involving the parties as follows: __________________________________ (Plaintiff) and ____________________________________ (Defendant).2.The object of this action or defense is as follows: ____________________________________.3.The real property affected by this action is located in ______________________________________ County, Alaska, and is legally described as follows:___________________________________.4.From the time of recording of this Notice, a purchaser, holder of a contract or option to purchase, or encumbrance of the property affected has constructive notice of the pendency of the action and of its pendency against parties designated by their real names. This the _____ day of ___________, 20_____. _________________________Signature Notice of Lis Pendens Page 2 of 3_________________________Print or Type NameState of Alaska _______________________ Judicial District_______________________ Claimant I, ___________________________________, being first duly sworn, on oath say that I am ________________________________ named in the foregoing claim; that I have heard the claim read, know the contents of it, and believe it is true. _________________________Signature_________________________Print or Type NameState of Judicial District (or County) of or Municipality of The foregoing instrument was acknowledged before me this __________________ (date) by _______________________________________ (name of person who acknowledged)._____________________________________Signature of Person TakingAcknowledgment__________________________Title or RankMy Commission Expires: Serial Number, if any Notice of Lis Pendens Page 3 of 3 Certificate of Delivery I, _____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing to ___________________________________ by: ( ) Personal Service with signed receipt ( )Mailing a true and correct copy of same by first-class U.S. mail, postage prepaid, return signed receipt requested to ___________________________,So certified this the ______ day of ___________________, 20____ . ________________________Signature AK § 34.35.080(c)