Notice Of Commencement Form - State Of Florida, County Of Palm Beach
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1NOTICE OF COMMENCEMENT
Permit No. _______________________
Tax Folio No. __________________________
State of Florida
County of Palm Beach
THE UNDERSIGNED hereby gives notice that improvements 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.
Project Address__________________________________________________________________________________________________________
Legal Description of Property__________________________________________________________________________________________
General description of improvement_________________________________________________________________________________________
Owner information a) Name and address _____________________________________________________________________________________
b) Interest in property_____________________________________________________________________________________
c) Name and address of fee simple titleholder (if other than owner _______________________________________________
Contractor (Name and address) ______________________________________________________________________________________
Phone number _____________________________
b) Fax number___________________________________
(optional, if service by fax is acceptable)
Surety a) Name and address___________________________________________________________________________________________
Phone number _________________ c) Fax number __________________ d) Amount of bond $_________________
(optional, if service by fax is acceptable)
Lender (Name and address) ____________________________________________________________________________________________
Phone number _____________________________
b) Fax number ___________________________________
(optional, if service by fax is acceptable)
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.
(Name and address) _______________________________________________________________________
Phone number ____________________________
b) Fax number ____________________________________
(optional, if service by fax is acceptable)
In addition to himself, owner designates ____________________________ of ______________________ to receive a copy of the Lienor’s Notice as provided in Section
713.13 (1) b, Florida Statutes.
Phone number ____________________________
b) Fax number_____________________________________
(optional, if service by fax is acceptable)
Expiration date of notice of commencement _____________________________ (the expiration date is one 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/Title
STATE OF FLORIDA
______________________________________________________________
COUNTY OF ______________________________
Printed Owner’s Name
The foregoing instrument was acknowledged before me this_______
day of ________ 20___ by_____________________________________
(Name and Title)
who is personally known to me or produced ______________ type of
identification.
My Commission Expires:_____________
_______________________________________________
Signature of Notary Public
_______________________________________________
(Name of Notary typed, printed or stamped)
Seal:
Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief.
_________________________________________________
Signature of Natural Person Signing Above
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