Fill and Sign the Notice of Delinquent Assessment Form

NOTICE OF DELINQUENT ASSESSMENT This notice is given pursuant to Civil Code section 1367 and _______________________ [describe applicable section of CC&Rs or other governing documents] recorded on ___________ [date], as Document Number __________, in the Official Records of _______________ County, California. From and after the date of recordation of this notice, the following amounts shall become a lien against the real property described below: 1. ______________________________________________________________________________________________________________________________________________ [Include legal description of real property and common street address and county.] 2. _______________________________________________ [Name of record owner.] 3. _______________________________________________ [Describe owner's interest.] 4. _______________________________________________ [State whether delinquent assessment is a regular or special assessment.]5. ___________________________ [Include amount of delinquent assessment] covering the period between ________________________ [date] and _________________ [date]. The delinquent assessment was due on _______________________ [date]. 6. _______________________________ [If applicable, add: Other charges incurred include: attorney fees to date in the amount of $_____________________ (Civil Code section 1366(d)(1)); charges for recordation of this notice $____________________ (Civil Code section 1366(d)(1)); late charges in the amount of $__________________ (Civil Code section 1366(d)(2)); total other charges in the amount of $______________.] 7. The total amount of the assessment is: ___________________ [add together amount of paragraphs 5 and 6], in the amount of $___________________, plus interest at the annual percentage rate of ______________ (not to exceed 12%), commencing on ____________ [date] 30 days after assessment due. [Civil Code section 1366(d)(3)] 8. __________________________________________________________________________________________________ [Name and address of authorized trustee for lien sale.] ____________________________________ [Name of association] Dated _____________________________ ___________________________________ Signature and title of authorized representative of association ACKNOWLEDGMENT State of CaliforniaCounty of On before me, (here insert name and title of the officer), personally appeared , who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal.Signature (Seal)