Fill and Sign the North Carolina Notice Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: __________________ Company: __________________ Address: ____________________ City: _________________ State: _____ Zip: __________ Phone: _______________ Fax: ________________ NOTICE OF ASSIGNMENT OF CLAIM OF LIEN ON REAL PROPERTY- INDIVIDUAL (N.C. Gen. Stat. § 44A-12(e)) The undersigned lien claimant __________________________________ hereby provides notice to _______________________________ (owner) that he or she assigned his or her claim of lien on real property which was recorded at __________________________________ on ________________ (date) for labor, materials, or laborers furnished for the purpose of improvements of real property located at and described as ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ , to ___________________________________ whose address is ______________________________________________________________________ . From the date of this notice, no arrangements or payments may be made without the assignee’s consent. Notice of Assignment of Claim of Lien on Real Property Page 1 of 2 This the _____ day of _______________ , 20 ______ . __________________________________ Signature of Lien Holder _____ _____________________________ Type or Print Name STATE OF NORTH CAROLINA COUNTY OF _____________________ I, a Notary Public, do hereby certify that _________________________________ (here give the name of the grantor or maker) personally appeared before me this day and acknowledged the due execution of the foregoing instrument. Witness my hand and (where an official seal is required by law) official seal This the ___________________ day of ___________________ (year). (Official seal.) ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________ Notice of Assignment of Claim of Lien on Real Property Page 2 of 2