Fill and Sign the Montana Corporation 497316150 Form

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 PUBLICATION--CORPORATION (M.C.A.§ 71-3-533) I, _________________________________ , as a representative of _________________________________ a __________________________________ corporation, do hereby certify under oath that I have published the attached Notice of Completion once each week for three (3) successive weeks in a newspaper of general circulation in the county where the land on which the work or improvement was performed is situated. This the _____ day of ______________ , 20 ______ . ______________________________ Signature _____ _________________________ Type or Print Name _____ _________________________ Title _____ _________________________ Corporation Attest: Secretary Affidavit of Publication Page 1 of 2 State of Montana County of ________________ _______________ (date) Signed and sworn to (or affirmed) before me on __________________________________ by ____________________________________ (name(s) of person(s) making statement). ______________________________ Notary Public (SEAL) Title (and Rank): _______________ Printed Name: _________________ Residing at:____________________ My Commission Expires: ______________ MT § 71-3-533(5) Affidavit of Publication Page 2 of 2