Fill and Sign the Notice of Claim Corporation Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: _________________ Company: __________________ Address: ____________________ City: ________________ State: ______ Zip: __________ Phone: ________________ Fax: ________________ Nature of Document: Notice of Claim of Lien Notice of Claim – Corporation (Utah Code Ann. §38-1-7) COMES NOW, __________________________________ , as a representative of __________________________________ a __________________________________ corporation performing services or furnishing materials or equipment for the improvement of the property located at and described as ________________________________________________________________________ _______________________________________________________________________ , and would state as follows: 1. The above-described property is owned by ______________________________________ , of the following address, if known: _______________________________________________________________________ . 2. The undersigned lien claimant was employed by, or furnished materials or equipment to ____________________________________ . 3. The undersigned lien claimant first performed labor and/or material on the _____ day of ______________ , 20 ______ , and last furnished same on the _____ day of _______________ , 20 ______ , resulting in costs to lien claimant of a total amount of $ ______________ for labor provided and/or materials furnished. 4. The undersigned lien claimant, _________________________________ , may be reached at the following address and phone number: _______________________________________________________________________ . 5. If the lien is on an owner-occupied residence, as defined in Utah Code Ann. §38-11-102, the owner, as defined in Utah Code Ann. §38-11-102, may require the undersigned lien claimant to remove the lien within 15 days in accordance with Utah Code Ann. §38-11-107 by obtaining a certificate of compliance and mailing a copy of the certificate of compliance by certified mail to the undersigned lien claimant at the above Notice of Claim Page 1 of 2 address. The 15-day period begins accruing from the date postmarked on the certificate of compliance sent to the lien claimant. This the _____ day of ________________ , 20 ______ . _______________________ Signature _____ __________________ Type or Print Name _____ __________________ Title _____ __________________ Corporation Attest: Secretary Acknowledgment of Corporation State of Utah County of __________________ On the ______ day of __________________ , 20 ______ , personally appeared before me ______________________________ ,who being duly sworn, did say that he/she is the ________________________ of ______________________________ , a corporation, and that said instrument was signed on behalf of said corporation by authority of a resolution of its Board of Directors, and said ______________________________ acknowledged to me that said corporation executed the same. (Seal) Notary Public My commission expires:             Type or Print Name Residing at:       Notice of Claim Page 2 of 2