Owner'S Dedication Block Sample Forms Page 4

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Note: Holders of all liens against the property being platted must be a part of the final plat or prepare
separate instruments which shall be filed for record with the plat.
EXAMPLE FORM
I, (or we), (name of mortgagee or names of mortgagees), owner and holder (or owners and holders) of
a lien (or liens) against the property described in the plat known as (name of plat), against the property
described instrument of record in Volume ________ , Page , of the Official Records (or Deed of Trust
Records) of Fort Bend County, Texas, do hereby in all things subordinate to said plat said lien(s) and I (or we)
hereby in all things subordinate to said plat said lien(s) and I (or we) hereby confirm that I am (or we are) the
present owner (or owners) of said lien(s) and have not assigned the same nor any part thereof.
(signature of lienholder)
By: (name to be printed)
Note: All lienholder signatures shall be acknowledged by a Notary Public.

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