CIV § 880.340

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 COUNTY RECORDER

After recording return to: Indexing instructions. This notice must be indexed as follows: Grantor and grantee index—each claimant is 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:

Certificate of acknowledgment required.