Fill and Sign the Written Statement of Recording Individual Form

Written Statement of Recording Page 1 of 2 WRITTEN STATEMENT OF RECORDING—CORPORATION, LLC, etc. On the _____ day of ___________, 20______, I, __________________________________, recorded a Notice of Completion regarding the project located at ___________________________________. The Notice of Completion is recorded in the County Recorder's Office of ________________________ County, Arizona. It is recorded at Book _______, Page ______, of Index ___________________. I am mailing this Statement to the following people who comprise the Contractor as well as all parties I received a Preliminary Twenty Day Notice from: Name Address____________________________________________________________________________________________________________________________________________ A copy of the Notice of Completion is attached.This the _____ day of ___________, 20______ . _______________________________ Name of CompanyBy: ____________________________________Signature Title______________________________Type or Print Name Written Statement of Recording Page 2 of 2 Certificate of Delivery I, _____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing Written Statement of Recording to ___________________________________ by: mailing a true and correct copy of Written Statement Recording by certified, registered U.S. mail, postage prepaid, to ___________________________, at his/her usual place of business located at ______________________________________. So certified this the ______ day of ___________________, 20____. ____________________________________Signature AZ § 33-993(I)