Fill and Sign the Washington Professional Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ___________________ Company: ____________________ Address: _____________________ City: __________________ State: _____ Zip: ___________ Phone: ___________________ Fax: ___________________ NOTICE OF FURNISHING PROFESSIONAL SERVICES- CORPORATION TO: Owner That on the _____ day of ________________ , 20 ______ , __________________________________ began providing professional services upon or for the improvement of real property legally described as follows: ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ . [Legal Description is mandatory] Assessor’s Property Tax Parcel No./Account No. ____________________________ . The general nature of the professional services provided is ________________________________________________________________________ _______________________________________________________________________ . The owner or reputed owner of the real property is _______________________ . ______________________________ Corporation By ______________________________ _____ _________________________ Type or Print Name Title _____ ________________________ _____ ________________________ Notice of Furnishing Professional Services Page 1 of 2 Street Address _____ _________________________ City, State, Zip Code _____ _________________________ Phone Number Attest: Secretary STATE OF WASHINGTON COUNTY OF ________________ On this ______ day of ________________ , __________ , before me, the undersigned, a Notary Public in and for the State of Washington, duly commissioned and sworn, personally appeared ___________________________________ and __________________________________ , to me known to be the ___________________________________ President and ___________________________________ Secretary, respectively, of ___________________________________ , the corporation that executed the foregoing instrument and acknowledged the said instrument to be the free and voluntary act of and deed of said corporation, for the uses and purposes therein mentioned, and on oath stated that __________________________________ authorized to execute the said instrument and that the seal affixed is the corporate seal of said corporation. Witness my hand and seal the day and year first above written. ______________________________ Notary Public residing at _________ Printed Name: _________________ My Commission Expires: _______________ WA § 60.04.034(5) Notice of Furnishing Professional Services Page 2 of 2