RECORDING REQUESTED BY AND WHEN RECORDED MAIL DOCUMENT AND TAX STATEMENT TO: NAME STREET ADDRESS CITY, STATE & ZIP CODE SPACE ABOVE THIS LINE FOR RECORDER’S USE ONLY RESTRICTIVE COVENANT MODIFICATION I (we) have an ownership interest of record in the property located at (Address) that is covered by the document described below. The following referenced document contains a restriction based on race, color, religion, sex, familial status, marital status, disability, national origin, source of income as defined in subdivision (p) of Section 12955, or ancestry that violated state and federal fair housing laws and that restriction is void. Pursuant to Section 12956.2 of the Government Code, this document is being recorded solely for the purpose of eliminating that restrictive covenant as shown on page(s) of the document recorded on (Date) in book and page of the official records of the County of San Bernardino. , or instrument number The document referenced above was originally indexed in the following manner and this document shall be indexed in like manner pursuant to Section 12956.2 (e): The effective date of the terms and conditions of this modification document shall be the same as the effective date of the original document referenced above. (Signature) (Signature) (Printed Name) (Printed Name) STATE OF ___________________________________________ COUNTY OF ______________________________________________ On before me, Approved as to form: San Bernardino County Counsel __________________________________________________________, a Notary Public/County Clerk (circle one) for said County and State, personally appeared By: Deputy County Counsel Date __________________________________________________________, proved to me on the basis of satisfactory 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 Rev. 3/21/07 Seal American LegalNet, Inc. www.FormsWorkflow.com