Recording requested by (name):
When recorded, mail to (name and address):
Recorder’s Use Only
Declaration of Exemption From Gov’t Code § 27388.1 Fee
Transfer is exempt from fee per GC § 27388.1(a)(2):
recorded concurrently “in connection with” transfer subject to DTT
recorded concurrently “in connection with” a transfer of
(Cal. Civ. Code § 8416)
residential dwelling to an owner-occupier
Transfer is exempt from fee per GC 27388.1(a)(1):
Fee cap of $225.00 reached
Not related to real property
_________________________________________________ (“claimant”) claims a mechanics lien for the labor
or services or equipment or materials described in paragraph 2, furnished for a work of improvement on that certain real
property located in the County of ____________________________, State of California, and more particularly described
as (address and/or sufficient description):______________________________________________________________
After deducting all just credits and offsets, the sum of _______________________, together with interest at the
rate of ________ per annum from __________________ (date when balance became due), is due claimant for the
following labor, materials, services, or equipment: _______________________________________________________
Claimant furnished the labor or services or equipment or materials, at the request of _____________________
_________________________________________________________________ (employer, person, or entity to whom
labor, materials, services, or equipment were furnished).
The name and address of the owner or reputed owner of the real property is/are: _______________________
Claimant's address is: ______________________________________________________________________.
I, _______________________________________, am the: __________________________________ (“owner,”
“president,” “authorized agent,” “partner,” etc.) of claimant on the foregoing claim of mechanics lien, and am authorized to
make this verification for and on its behalf. I have read the foregoing claim of mechanics lien and know the contents of the
claim of mechanics lien to be true of my own knowledge.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.