The undersigned is the Owner of Real Estate described below and hereby designates as its Mechanic’s Lien Agent, as defined in Virginia Code Section 43-1, Newtown Title Agency, Inc., 804 Newtown Road, Suite 104, Virginia Beach, Virginia, 23462, (757) 473-3533.

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OWNER OF REAL ESTATE:

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Name (Please Print)

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Signatory (Please Print)

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(Signature)

Date:__________________________________

NEWTOWN TITLE AGENCY, INC. hereby consents to act as Mechanics’ Lien Agent for the Owner of Real Estate for the purpose of receiving notice pursuant to Virginia Code Section 43-4.01.

NEWTOWN TITLE AGENCY, INC.

BY:____________________________________

DATE:__________________________________