This Instrument Prepared By:

Name_________________________________

Address_______________________________

Permit No._________ Tax Folio No._________

NOTICE OF COMMENCEMENT

STATE OF ________________,

COUNTY OF ______________.

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 property, and street address if available)

2. General description of improvement:

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 different from owner listed above):

4. Contractor:

a. Name and address:

b. 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 $ .

6. Lender:

a. Name and address:

b. 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. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section

713.13(1)(b), Florida Statutes:

a. Name and address:

b. Phone number of person or entity designated by Owner:

9. Expiration date of notice of commencement (the expiration date may not be before the completion of construction and final payment to the contractor, but will be1 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.

Under penalty of perjury, I declare that I have read the foregoing and that the facts stated therein are true to the best of my knowledge and belief.

___________________________________________________

Signature of Owner or Lessee, or Owner’s or Lessee’s Authorized Officer/Director/Partner/Manager

Signatory’s Title/Office_________________________________

The foregoing instrument was acknowledged before me this _____ day of ___________________, 2_____ (year) by _______

____________________________ (name of person) as _____________________________________________ (type of authority, …e.g. officer, trustee, attorney in fact) for ___________________________________________ (name of party on behalf of whom instrument was executed).

___________________________________________________

Signature of Notary Public – State of Florida

Print, Type, or Stamp Commissioned Name of Notary Public

Commission Number

Personally Known ___ or Produced Identification____________

NOTE: This statutory form was revised by the 2011 Florida Legislature

and has an effective date of October 1, 2011.