Fill and Sign the South Dakota Form

Notice of Non-Liability – Individual (S.D. Codified Laws Ann. §44-9-4) COMES NOW, __________________________________ , as a party with an interest in the property undergoing improvement located at and described as ___________________________________________________________ , and would provide notice of the following: 1. The undersigned became aware that the above-described property was undergoing improvements on the _____ day of ______________ , 20 _______ . 2. The undersigned would hereby provide notice that said improvements are not being furnished at the instance of, and were not authorized by, the undersigned. 3. Further, with the furnishing of this notice to parties performing improvements, or the posting of this notice in a conspicuous place on the premises, the interest of the undersigned in the above-described property shall not be subject to any claims or liens as a result of said improvements. This the _____ day of ____________ , 20 _______ . _________________________ Signature _____ ____________________ Type or Print Name Notice of Non-Liability Page 1 of 2 Certificate of Delivery I, ____________________________________ , hereby certify that I have delivered this day a true and correct copy of the foregoing to __________________________________ by: ( ) Personal Service ( ) Mailing a true and correct copy of same by certified or registered U.S. mail, postage prepaid, return receipt requested to ______________________________________ . So certified this the _____ day of _________________ , 20 ______ . ________________________ Signature Notice of Non-Liability Page 2 of 2