2021 Tennessee Code
Part 5 - Commercial Real Estate Brokers
§ 62-13-501. Part Definitions — Form of Notice

As used in this part, unless the context otherwise requires:
NOTICE OF AGREEMENT TO PAY LEASING COMMISSION
THIS NOTICE is made as of this  day of  ,  , in accordance with the provisions of T.C.A. Section 62-13-501. The undersigned [Name of Broker][address] makes claim to fees or commissions with respect to the following real property located in the State of Tennessee [property must be identified below by County and City (if any) and by either lot and block or subdivision number, or metes and bounds description].
County:
City:
Lot And Block No. or Subdivision/Development Name:
Property (Metes and Bounds) Description (either fill in here or attach Exhibit):
[The Broker], is entitled to be paid certain leasing fees or commissions as a result of securing a tenant for the real property from the above-described real property pursuant to one or more provisions of the following written instrument (the “Instrument”):
Name/Title of Instrument:
Date of Instrument:
Name of Parties to Instrument:
The Owner of the Property Is:
[NOTE: Any party seeking details or any other information regarding the Instrument shall rely only on the Instrument. Without the express written consent of all parties to the Instrument, neither the Instrument nor any other information regarding the Instrument shall be included in this Notice.]
THIS NOTICE made for the purpose set out above to be effective as of the day and date first above written.
STATE OF
COUNTY OF
The Undersigned Broker, being first duly sworn, hereby certifies that the foregoing Notice of Agreement to Pay Leasing Commission is true and correct, and that the agreement to pay leasing fees or commissions remains in force and has not been terminated.
This the  day of  ,
BROKER:
By:
Print Name:
Title:
[NOTE: Insert the appropriate acknowledgment form as required by law and have the broker's signature properly acknowledged.];

Structure 2021 Tennessee Code