Permit No Tax Parcel Number NOTICE OF COMMENCEMENT State of Florida County of Volusia 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 1. Description of Property: (Legal description of the property, and street address if available.) 2. General description of improvement: FOR CLERK222S OFFICE USE ONLY 3. Owner information or Lessee information if the Lessee contracted for the improvement: a. Name and address b. Interest in property c. Name and address of fee simple titleholder (if other than owner) 4. a. Contractor: Name and address b. Contractor222s phone number 5. Surety (if applicable, a copy of the payment bond is attached): a. Name and address b. Phone number c. Amount of bond $ .00 6. a. Lender: Name and address b. Lender222s phone number 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes: a. Name and address b. Phone numbers of designated persons: 8. a. In addition to himself, Owner designates of to receive a copy of the Lienor222s Notice as provided in Section 713.13(1)(b), Florida Statutes b. Phone number 9. Expiration date of Notice of Commencement (the expiration date is 1 year from the 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. Signature of Owner or Lessee, or Owner222s or Lessee222s Authorized Officer/Director/Partner/Manager (Section 713.13[1] [d]) Signatory222s Title/Office State of , County of The forgoing instrument was acknowledged before me this day of 20 by , (Type of authority 205e.g. officer, trustee, attorney in fact) Signature of Notary Public - State of Florida Print, Type or Stamp Name of Notary Public Personally Known OR Produced ID Type of ID Produced 04.04.14 Volusia County Permit Center Fax # 386-822-5734 American LegalNet, Inc. www.FormsWorkFlow.com