Permit No.	Tax Folio No.

NOTICE OF COMMENCEMENT

STATE OF

COUNTY OF

THE UNDERSIGNED hereby gives notice that improvement 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.

1.	Description of property (legal description and street address, if available):

2.	General description of improvement:

3.	Owner information:

a)	Name and address:

b)	Interest in property:

c)	Name and address of fee simple title holder (if other than Owner):

4.	Contractor (name and address):

5.	Surety:

a)	Name and address:

b)	Amount of bond: $

6.	Lender (name and address):

7.	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)

8.	In addition to himself, Owner designates of	(address) to receive a copy of the Lienor's Notice as provided in section 713.13(1)(b), Florida Statutes.

9.	Expiration date of notice of commencement (the expiration date is one year from the date of recording unless a different date is specified):

(Owner)

By:

Print Name:

Print Title:

Address:

STATE OF

COUNTY OF

SWORN TO and subscribed before me this day of	,

, by (name), as (title) of (name of corporation), a (State) corporation, on behalf of the corporation. He/She [please check as applicable] / / is personally known to me, or has produced /______/ his/her (state) driver's license, or / / his/her / / (type of identification) as identification.

(Signature)

(Printed Name)

NOTARY PUBLIC, STATE OF FLORIDA

(Commission Expiration Date)