Subject to all statutory requirements for recorded documents, a notice of intent to preserve an interest in real property shall be in substantially the following form:
RECORDING INFORMATION
Recording requested by:
FOR USE OF COUNTYRECORDER
After recording return to:
Indexing instructions.This notice must beindexed as follows:
Grantor and granteeindex—each claimantis a grantor.
NOTICE OF INTENT TO PRESERVE INTEREST
This notice is intended to preserve an interest in real property from extinguishment pursuant to Title 5 (commencing with Section 880.020) of Part 2 of Division 2 of the Civil Code (Marketable Record Title).
Claimant
Name:
Mailing address:(must be given for each claimant)
Interest
Character (e.g., power of termination):
Record location of document creating or evidencing interest in claimant:
Real Property
Legal description (may be same as in recorded document creating or evidencing interest in claimant):
I assert under penalty of perjury that this notice is not recorded for the purpose of slandering title to real property and I am informed and believe that the information contained in this notice is true. If this notice is made on behalf of a claimant, I assert under penalty of perjury that I am authorized to act on behalf of the claimant.
Signed:
(claimant)
(person acting on behalf
of claimant)
Date:
State of ___________________,County of _________________, ss.On this _____ day of ________, in the year _____, before me (here insert name and quality of officer), personally appeared ______________, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to this instrument, and acknowledged that he (she or they) executed it.
Signed:Office:
Official Seal: