Fill and Sign the Notice Completion 497326718 Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ___________________ Company: ____________________ Address: _____________________ City: ____________________ State: ______ Zip: __________ Phone: ___________________ Fax: ____________________ Reference Instrument Number: ________________ This instrument was prepared by: Name: ___________________________________ Address: _______________________________________________________________ NOTICE OF COMPLETION--INDIVIDUAL (Tenn. Code Ann. § 66-11-143) COMES NOW, ___________________________________ , and would hereby provide notice of the following: 1. The legal name of the owner or owners of the real property is/are: ____________________________________________________________ . 2. The names of all applicable prime contractors are: ____________________________________________________________ . 3. The location and description of the real property is: ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ . 4. The date of completion of the entire improvement was the _____ day of _______________ , 20 ______ . 5. A transfer of ownership of all or a part of the real property or an interest therein and encumbrance thereon or a settlement of the claims of parties entitled to the benefits of Title 66, Chapter 11 of the Tennessee Code Annotated will take place not less than ten (10) days after the date of the recording of this notice of completion; provided, that the ten-day expiration for lien claimants shall only apply to contracts for improvement to or on real property for one-family, two-family, three-family and four-family residential units. On all other contracts for improvement to or on real property, the expiration time Notice of Completion Page 1 of 2 for lien claimants shall be thirty (30) days after the date of the recording of this notice of completion. The name and address of the person, firm or organization on which parties entitled to the benefits of Title 66, Chapter 11, may service notice is as follows: Name: ___________________________________ Street Address: __________________________________________________________ City: _________________________ State: _______________ Zipcode:. ___________ This the _____ day of _____________ , 20 ______ . _________________________________ Signature (check one) Owner Purchaser Prime Contractor _____ ____________________________ Type or Print Name State of Tennessee County of __________________ Personally appeared before me, the undersigned, a Notary Public within and for said State and County aforesaid, duly commissioned and qualified, ________________________ , the within named bargainers, with whom I am personally acquainted, or proved to me on the basis of satisfactory evidence, and who acknowledged that they executed the foregoing instrument for the purposes therein contained. Witness my hand and seal at office this ______ day of __________________ , 20 ______ . Notary Public My commission expires:       Type or Print Name Notice of Completion Page 2 of 2