Fill and Sign the Notice of Commencement Form

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 COMMENCEMENT - INDIVIDUAL STATE OF FLORIDA COUNTY OF ___________________ . THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of 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: ______________________________________________________________________________ _____________________________________________________________________________ . b. Interest in property: ___________________________________________ . c. Name and address of fee simple titleholder (if other than owner): Notice of Commencement Page 1 of 4 ______________________________________________________________________________ _____________________________________________________________________________ . 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: a. Name and address: ______________________________________________________________________________ _____________________________________________________________________________ . b. Phone number: ______________________ . Notice of Commencement Page 2 of 4 c. Fax number (optional, if service by fax is acceptable): ____________________ . 9. Expiration date of notice of 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 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 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 COMMENCING WORK OR RECORDING YOUR NOTICE OF 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 acknowledging), who is personally known to me or who has produced ________________________ (type of identification) as identification. ______________________, CLERK OF CIRCUIT COURT ____________________________________ _______________________________________ (Signature of Deputy Clerk) (Signature of Notary Public — State of Florida) Notice of Commencement 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 Commencement Page 4 of 4