Fill and Sign the Notice Nonresponsibility 497320614 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 NONRESPONSIBILITY--Corporation (N.R.S. §108.234) BE IT NOW KNOWN THAT the undersigned corporate representative of the disinterested owner of _________________________________________________________________ (address), having an interest described as ___________________________________ (nature and extent of the disinterested owner’s interest in the improvement and the property upon which the improvement is or will be constructed, altered or repaired) in the property undergoing improvements at ________________________________________________________________ and legally described as ________________________________________________________________________ ________________________________________________________________________ (location of the improvement and the address and legal description of the property upon which the improvement is or will be constructed, altered or repaired) (If legal description is provided in metes and bounds, also include the name and mailing address of the person who prepared the legal description. If a document including the same legal description previously has been recorded, include all information necessary to identify and locate the previous recording, but not the name and mailing address of the person who prepared the legal description), by _________________________________ (person who is causing the work of improvement to be constructed, altered or repaired) of ________________________________________________________________ (address) having obtained knowledge on _____ day of ______________ , 20 ______ of these improvements within three days of the filing of this notice, hereby places all parties on notice that the undersigned shall not be responsible for said improvements. If the disinterested owner is a lessor, the undersigned has or has not notified the lessee in writing that the lessee must comply with the requirements of N.R.S. §108.2403, if applicable. This the ______ day of ______________ , 20 _______ . Notice of Non-responsibility Page 1 of 3 ______________________________ Corporation ______________________________ By _____ _________________________ Print Name _____ ________________________ Title Attest: Secretary NV § 108.234 State of Nevada County of _______________ This instrument was acknowledged before me on _____________ by ___________________________________ as ____________________ (type of authority, e.g., officer, trustee, etc.) of ___________________________________ (name of party on behalf of whom instrument was executed). ________________________ (Signature of notarial officer) (Seal, if any) _________________________ (Title and rank (optional)) (My commission expires (optional): ________ ) CERTIFICATE OF DELIVERY I,       , hereby certify that I have delivered this day a true and correct copy of the foregoing to       by: (select one of the options) Personal Service; or Notice of Non-responsibility Page 2 of 3 By mailing a copy of the above document by certified mail, return receipt requested, on the above individual at the following address:                   So certified this the ______ day of ___________________, 20____. Signature       Print/Type Name Notice of Non-responsibility Page 3 of 3