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 COUNTYRECORDER
After recording return to:
Indexing instructions.This notice must beindexed as follows:
Grantor and granteeindex—each claimantis 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.
Source:
Section 880.340, https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=CIV§ionNum=880.340..