THIS INSTRUMENT PREPARED BY: Name: Address: NOTICE OF COMMENCEMENT State of Florida County of Seminole Permit Number: Parcel ID Number: The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available) GENERAL DESCRIPTION OF IMPROVEMENT: OWNER INFORMATION: Name: Address: Fee Simple Title Holder (if other than owner) Name: Address: CONTRACTOR: Name: Address: Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served as provided by Section 713.13(1)(b), Florida Statutes. Name: Address: In addition to himself, Owner Designates of To receive a copy of the Lienor's Notice as Provided in Section 713.13(1)(b), Florida Statutes. Expiration Date of Notice of Commencement (The expiration date is 1 year from date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief. Owner's Signature Owner's Printed Name Florida Statute 713.13(1)(g): " The owner must sign the notice of commencement and no one else may be permitted to sign in his or her stead." State of County of day of . Who is personally known to me Name of person making statement The foregoing instrument was acknowledged before me this by OR who has produced identification , 20 type of identification produced: SEAL Notary Signature American LegalNet, Inc. www.FormsWorkFlow.com