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, SOUTHERN TITLE SERVICES, INC., Three James Center, 1051 East Cary Street, Suite 700, Richmond, Virginia 23219, Telephone Number (804) 648-6000, Fax (804) 788-4956, Attention: Gail E. Markey.

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OWNER OF REAL ESTATE:

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Name of Company, if any (Please Print)

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Signatory (Please Print)

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(Signature)

Date:__________________________________

If a policy of title insurance is issued by Southern Title Insurance Corporation (STIC) in connection with construction of a one-or-two family residence on the property described above (directly or through one of its agents), SOUTHERN TITLE SERVICES, INC. (STSI) hereby automatically consents to act as Mechanics’ Lien Agent for the Owner(s) of Real Estate for the purposes of receiving notice(s) pursuant to Virginia Code Section 43-4.01. A signature below from an authorized signatory of STSI is necessary when no policy is issued by STIC.

SOUTHERN TITLE SERVICES, INC.

BY:____________________________________

DATE:__________________________________

STIC Form #130