Cal. Civil Code § 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 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.