Fill and Sign the Request for Notice of an Election Form

Request for Notice of an ElectionPage 1 of 3CA Civil Code § 8538 REQUEST FOR NOTICE OF AN ELECTION (Business Entity as Lien Claimant) COMES NOW, , lien claimant who has furnished labor, services, equipment and/or materials for the work of improvements to the property at: Street Address: City, State, Zip: and who has given , the construction lender, a stop payment notice or bonded stop payment notice, and hereby makes a written request for notice of an election regarding the withholding of funds. The undersigned attaches hereto a preaddressed, stamped envelope for use by the construction lender in providing the claimant such notice within thirty (30) days after making the election. You will be held liable for failure to furnish a copy of the bond, unless the failure was not intentional and resulted from a bona fide error; you maintain reasonable procedures to avoid such an error; and if you correct the error not later than twenty (20) days from the date on which your violation is discovered. Date: Name of Entity: ATTESTED BY: (if required) A Corporation By: Signature Signature of authorized signatory Type or Print NameType or Print Name Its: Position or Rank Capacity of Signatory Request for Notice of an ElectionPage 2 of 3CA Civil Code § 8538 PROOF OF NOTICE DECLARATION (Civil Code § 8118) I, , declare that I have served copies of the REQUEST FOR NOTICE OF AN ELECTION by (check appropriate box below):a. By personally delivering copies to:Name Lending Institution: Branch: Individual in charge of account: At: (Street Address) City, State and Zip Code: On: , 20 , at am / pm.[Provide the above information for all other parties personally served on attached Exhibit A] b. By Certified, Express, or Registered Mail Service, postage prepaid addressed to: Name Lending Institution: Branch: Individual in charge of account: At: Street Address: City, State and Zip Code: On: , 20 [Provide the above information for all other parties served by mail / express service on attached Exhibit A] See attached documentation provided by the US Postal Service or express mail service showing the date of delivery and the name of the person accepting delivery; tracking record or other documentation from express carrier showing attempted delivery or delivery of the notice; or, in the event of non-delivery, the returned envelope itself.I declare under penalty of perjury that the foregoing is true and correct. Signed at , California , on , 20______.Signature Print or Type NameA notary public or other officer completing the certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.State of California County of ______________________On ______________________ before me, ______________________ (here insert name and title of the officer), personally appeared ______________________, who proved to me on the basis of Request for Notice of an ElectionPage 3 of 3CA Civil Code § 8538satisfactory 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)