Fill and Sign the Notice Form Construction 497302784

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ___________________ Company: ___________________ Address: _____________________ City: __________________________ State: _____ Zip: _____________ Phone: _____________________ Fax: _______________________ Permit No. ______________________ Tax Folio No. ____________________ NOTICE OF RE-COMMENCEMENT- INDIVIDUAL STATE OF FLORIDA COUNTY OF ___________________ . THE UNDERSIGNED hereby gives notice that improvement will be recommenced to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Re-commencement. 1. Description of property: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (legal description of the property, and street address if a vailable ) 2. General description of improvement: ______________________________________________________________________________ _____________________________________________________________________________ . 3. Owner information a. Name and address: Notice of Re-Commmencement Page 1 of 4 ______________________________________________________________________________ _____________________________________________________________________________ . b. Interest in property: ___________________________________________ . c. Name and address of fee simple titleholder (if other than owner): ______________________________________________________________________________ _____________________________________________________________________________ . 4. Contractor: a. Name and address: ______________________________________________________________________________ _____________________________________________________________________________ . b. Phone number: _________________________________ . c. Fax number (optional, if service by fax is acceptable): _____________________ . 5. Surety a. Name and address: ______________________________________________________________________________ _____________________________________________________________________________ . b. Amount of bond $ _______________________ c. Phone number: ______________________________ . d. Fax number (optional, if service by fax is acceptable): ____________________ . 6. Lender a. Name and address: ______________________________________________________________________________ _____________________________________________________________________________ . b. Phone number: ____________________________ . c. Fax number (optional, if service by fax is acceptable): ____________________ . 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(l)(a)7., Florida Statutes: a. Name and address: ______________________________________________________________________________ _____________________________________________________________________________ . b. Phone number: _____________________ . c. Fax number (optional, if service by fax is acceptable): _____________________ . 8. In addition to himself or herself, Owner designates the following person(s) to receive a copy of the Lienor’s Notice as provided in Section 713.13(l)(b), Florida Statutes: Notice of Re-Commmencement Page 2 of 4 a. Name and address: ______________________________________________________________________________ _____________________________________________________________________________ . b. Phone number: ______________________ . c. Fax number (optional, if service by fax is acceptable): ____________________ . 9. Expiration date of notice of re-commencement (the expiration date is 1 year from the date of recording unless a different date is specified) ______________________ . WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF RE-COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF RE-COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RE-COMMENCING WORK OR RECORDING YOUR NOTICE OF RE-COMMENCEMENT. _______________________________________ _____________________________ (Signature of Owner or Owner’s Authorized (Signatory’s Title/Office) Officer/Director/Partner/Manager) _____ ___________________________________ Type or Print Name The foregoing instrument was acknowledged before me this __________ day of __________, (year), by ______________________ (name of person) as _________________________ (type of authority, … e.g. officer, trustee, attorney in fact) for ___________________________ (name of party on behalf of whom instrument was executed). ______________________, CLERK OF CIRCUIT COURT ____________________________________ _______________________________________ (Signature of Deputy Clerk) (Signature of Notary Public — State of Florida) ____________________________________ _______________________________________ Notice of Re-Commmencement Page 3 of 4 (Printed Name of Deputy Clerk) (Print, Type, or Stamp Commissioned Name of Notary Public) Personally Known __________ OR Produced Identification __________ Type of Identification Produced ________________________________ Verification Pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief. ______________________________________ (Signature of Natural Person Signing Above) Certificate of Service I, _____________________________________, hereby certify that I have delivered this day a true and attested copy of the foregoing to ___________________________________ by: ( ) Actual Delivery to the person to be served. ( ) Mailing a true and correct copy of same by registered or certified U.S. mail, with postage prepaid, or by overnight or second-day delivery with evidence of delivery. ( ) If service cannot be made by the above methods, by posting on the premises. ________________________ Signature Notice of Re-Commmencement Page 4 of 4