Fill and Sign the New York Extension Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: _____________________ Company: _____________________ Address: _______________________ City: ____________________ State: _____ Zip: _________ Phone: _________________ Fax: ___________________ EXTENSION OF NOTICE OF MECHANIC’S LIEN (Corporation) TO THE CLERK OF __________________ COUNTY, STATE OF NEW YORK AND ALL OTHERS WHOM IT MAY CONCERN: PLEASE TAKE NOTICE, that ______________________________ , lienor, a __________________ corporation, authorized to do business in the State of New York, pursuant to Section 17 of the Lien Law of the State of New York, hereby extends for a period of one year from the filing hereof, that certain Notice of Lien filed in this office by said Lienor on __________________ , against the real property located in __________________ , in the Town of __________________ , County of __________________ , State of New York, and being shown on the __________________ County Tax Map in Section ____________ , Block ____________ , Lot ____________ and being more particularly bounded and described as follows:       Extension of Notice of Mechanic’s Lien Page 1 of 3 The owner of said real property against whose interest therein the lien is claimed is ______________________________ and the name of the contractor is ______________________________ . The amount of said lien is $ ____________ . The above name lienor requests that, pursuant to Section 17 of the Lien Law of the State of New York, the aforementioned lien be re-docketed as of the date of the filing of this extension. Dated; __________________ ________________________ Signature _____ ___________________ Type or Print Name _____ ___________________ Title _____ ___________________ Corporation Attest: Secretary I, _______________________________, do hereby swear or affirm that the matters alleged and things contained in the above Notice of Lien are true and correct to the best of my knowledge, information, and belief. ________________________ Affiant STATE OF NEW YORK COUNTY OF _________________ On the _____ day of _______________ in the year ________ before me personally came ___________________________________ to me known, who, being by me duly sworn, did depose and say that he/she/they reside(s) in ________________________________________________________________________ (if the place of residence is in a city, include the street and street number, if any, thereof); that he/she/they is (are) the ___________________________________ (president or other officer or director or attorney in fact duly appointed) of the __________________________________ (name of corporation), the corporation Extension of Notice of Mechanic’s Lien Page 2 of 3 described in and which executed the above instrument; and that he/she/they signed his/her/their name(s) thereto by authority of the board of directors of said corporation. ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________ Extension of Notice of Mechanic’s Lien Page 3 of 3