Fill and Sign the Undersigned as a Representative of a Form

Notice of Commencement Page 1 of 3 NOTICE OF COMMENCEMENT - CORPORATION STATE OF NEBRASKA COUNTY OF ___________________ THE UNDERSIGNED as a representative of _________________________________ a _________________________________ corporation, hereby gives notice that improvement will be made to certain real property, and in accordance with NRS § 52-145, the following information is provided in this Notice of Commencement. 1. Description of real estate being or intended to be improved or directly benefited: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ (legal description of the property, and street address if available) 2. General description of improvement: ___________________________________________________________________________________________________________________________________________________________. 3. Owner informationa. Name and address: ___________________________________________________________________________________________________________________________________________________________. b. Interest in real estate:___________________________________________. c. Name and address of fee simple titleholder (if other than contracting owner): ___________________________________________________________________________________________________________________________________________________________. 4. If, after the notice of commencement is recorded, a lien is recorded as to an improvement covered by the notice of commencement, the lien has priority from the t ime the notice of commencement is recorded. Notice of Commencement Page 2 of 3 5. Expiration date of notice of commencement (if an expiration is stated of less t han six months from the date of recording, then expiration is six months and the expiration date is 1 year from the date of recording unless a different date is specified) ______________________. _______________________________________ _____________________________ (Signature of Owner or Owner’s Authorized (Signatory’s Title/Office) Officer/Director/Partner/Manager) ________________________________________ ______________________________ Type or Print Name Name of Corporation Attest: Secretary State of Nebraska County of __________________ The foregoing instrument was acknowledged before me this __________________ (date) by ______________________________ (name of officer or agent, title of officer or agent) of ________________________ (name of corporation acknowledging) a ________________________ (state or place of incorporation), on behalf of the corporation. Signature Title or Rank Serial Number, if any: Type or Print Name Prepared by and Return to: (name and address) Notice of Commencement Page 3 of 3 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