Fill and Sign the Oregon Notice 497323617 Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ____________________ Company: _____________________ Address: _____________________ City: _________________ State: _____ Zip: __________ Phone: ________________ Fax: ________________ Name of Claimant: ________________________________ Name of Debtor: ________________________________ Amount of Lien: _________________ Tax Assessor’s Account Number: _________________ Situs Address of Real Property: ________________________________________________________________________ NOTICE OF NON-RESPONSIBILITY – INDIVIDUAL (Or. Rev. Stat. §87.030) COMES NOW, ________________________________ , as the owner of the property undergoing improvements located at and described as ________________________________________________________________________ ______________________________________________________________________ (legal description that includes a metes and bounds description; a lot, block, subdivision; the book and page and/or instrument number of a recorded deed where the legal can be found; or a parcel in a partition) , and would state as follows: 1. The undersigned property owner became aware that the above-described property was in the process of being improved on the _____ day of _____________ , 20 ______ . 2. The undersigned hereby provides notice that said improvements are not being carried out at the instance of the undersigned owner and that the above-described property shall not be subject to a lien for any labor performed or materials provided. This the _____ day of ______________ , 20 ______ . _________________________ Signature _____ ____________________ Type or Print Name Notice of Non-Responsibility Page 1 of 2 _____ ____________________ _________________________ Address Notice of Non-Responsibility Page 2 of 2