(2) A lien notice in substantially the following form shall be sufficient for purposes of subsection (1): BROKER'S COMMISSION LIEN NOTICE UNDER FLORIDA COMMERCIAL REAL ESTATE LEASING COMMISSION LIEN ACT
Notice is hereby given, pursuant to the Florida Commercial Real Estate Leasing Commission Lien Act, part IV of chapter 475, Florida Statutes (the "act"), that the undersigned real estate broker is entitled to receive a leasing commission from the owner named below pursuant to the terms of a written brokerage commission agreement regarding a lease of the commercial real estate described below, and the undersigned broker claims a lien under the act against the owner's interest in the commercial real estate in the amount set forth below.
1. Name of the owner who is obligated to pay the commission:2. (Check one:) The owner obligated to pay the commission is: [ ] the landlord under the lease.
[ ] the tenant under the lease.
3. Name of the person owning the fee simple interest in the commercial real estate, if other than the owner who is obligated to pay the commission:4. Legal description of the commercial real estate:5. Name, mailing address, telephone number, and Florida broker license number of the undersigned broker:6. Effective date of the written brokerage commission agreement between the owner and the broker under which the commission is or will be payable:, .7. Amount of commission claimed by the undersigned broker: $, or percent of rents payable under lease, or
[specify other formula for determination of commission amount]:.
8. The lease for which the commission is claimed is described as follows [provide all information known to the broker]: Name of landlord:
Name of tenant:
Date of lease: ,
Leased premises:
9. Automatic renewal commissions (check yes or no): Is the undersigned broker claiming a commission that may become payable if the lease is later renewed or modified to expand the leased premises or to extend the lease term, but the written brokerage commission agreement does not expressly require the broker to perform any additional services in order to receive this later commission? [ ] Yes
[ ] No
If yes, specify the amount of such later commission or the formula for computing the later commission:
10. The expiration date of this lien notice is 2 years after the date of recording, unless the answer to paragraph 9 is yes, in which case the expiration date of this lien notice for the commission described in paragraph 9 is 10 years after the date of recording.11. The undersigned broker, under penalty of perjury, hereby swears or affirms that the undersigned broker has read this lien notice, knows its contents and believes the same to be true and correct, and that the undersigned broker is making this commission claim pursuant to the written brokerage commission agreement described in this lien notice. Signed: (broker)
Signed and sworn to or affirmed under penalty of perjury before me, a notary public, this day of,, by.
Signed: (notary public)