Fill and Sign the Louisiana Termination Form

NOTICE OF TERMINATION--CORPORATION (La.Rev.Stats § 9:4822-E) COMES NOW, __________________________________, as a representative of _______________________________ a ________________________________ corporate Owner or Owner’s representative whose address is ________________________________________________________________, and hereby gives notice that a written contract dated the _____ day of __________________, 20______, between _______________________________ as Owner and _____________________________ as Contractor for work performed as stated below, has been terminated, and in good faith certifies the following: (1) The immovable upon which work was performed and the work to which it relates is located at and described as: _______________________________________________________________. (2) A notice of contract was filed or recorded on __________________ (date), if applicable. (3) The contract is terminated because: The work has been substantially completed; The work has been abandoned by the owner; or A contractor is in default under the terms of the contract. This the _____ day of ______________, 20_________. ______________________________ Signature of Owner or Representative ________________________________ Type or Print Name ________________________________ Title ________________________________ Name of Corporation Attest: Secretary Notice of Termination Page 1 of 3 STATE OF LOUISIANA COUNTY OF ___________________ On this ________ day of ________, 20__, before me appeared ______________________________, to me personally known, who, being by me duly sworn (or affirmed) did say that he or she is the president (or other officer or agent of the corporation or association), of ______________________ (describing the corporation or association), and that the seal affixed to said instrument is the corporate seal of said corporation (or association) and that the instrument was signed and sealed in behalf of the corporation (or association) by authority of its Board of Directors (or trustees) and that ________________________ acknowledged the instrument to be the free act and deed of the corporation (or association) or that the corporation (or association) has no corporate seal. ______________________________ Notary Public ______________________________ Type or Print Name ______________________________ Title (and Rank) (Seal, if any) My appointment expires: ___________________ Notice of Termination Page 2 of 3 Certificate of Delivery I, , hereby certify that I have delivered this day a true and correct copy of the foregoing to Notice of Termination by: Personal Service Mailing a true and correct copy of the same by registered or certified U.S. Mail, postage prepaid, return receipt requested to , located at _________________________________________. Certified or Registered Mail Number(s): . So certified this the ______ day of __________________, 20______. Signature Notice of Termination Page 3 of 3