Notice Of Intent To File A Lien Or Claim Page 2

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THE STATE OF TEXAS §
COUNTY OF TRAVIS
§
SUBSCRIBED AND SWORN TO BEFORE ME by ____________________, Financial Services Representative,
(Representative’s Name)
____________________________, this ____________________________.
(Name of your firm)
(Day, Month, Year)
__________________________________________
Notary Public
PROOF OF SERVICE BY MAIL AFFIDAVIT
I declare that I served a copy of the above notice and any related documents, by first-class mail, registered and
return receipt requested (as required by law), addressed to the aforementioned parties on __________. I declare
(MM/DD/YY)
under penalty of perjury that the foregoing is true and correct. Executed at
____________________________________ .
(City, County, Texas on Date)
BY: ______________________________________
Financial Services Secretary
Notice of Intent to File a Lien or a Claim
Issue/Review Date: June 11, 2007

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