Of claim of title to real property. This notice of claim to real property, is filed pursuant to chapter _________, section _________, of the _________ statutes of the state of _________. 1. The name of the claimant [or claimants] is [or are] _________. 2. The name [or names] of the present record owner [or owners] of the land described in the next following paragraph is [or are] _________. 3. The land affected by this claim is described as follows: _________. 4. This claim is based on _________[give complete description of instrument or transaction (act, event, or omission), on which the claim is founded, with the date, volume and page of recording if it is recorded]. [Date] [Signature or signatures]
[Verification]