Business and Professions Code section 8764.5

Statements shall appear on the map as follows:

Surveyor’s Statement

This map correctly represents a survey made by me or under my direction in conformance with the requirements of the Professional Land Surveyors’ Act at the request of

Name of Person Authorizing Survey

in _______, 20__.

(Signed and sealed)

L.S. (or R.C.E.) No.

County Surveyor’s Statement

This map has been examined in accordance with Section 8766 of the Professional Land Surveyors’ Act this ____ day of ____, 20__.

(Signed and sealed) County Surveyor

L.S. (or R.C.E.) No.

Recorder’s Statement

Filed this ____ day of ____, 20__, at ____.m. in Book ____ of ____ at page ____, at the request of ____.

(Signed) County Recorder

No other statements may appear on the face of the map except those required or authorized by this article.