Fill and Sign the Assignment of Lien Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: _____________________ Company: _____________________ Address: _____________________ City: _________________________ State: ______ Zip: __________ Phone: ______________________ Fax: _________________________ ASSIGNMENT OF LIEN- CORPORATION or LLC (Colorado Revised Statute § 38-22-117) Beginning on or about the _____ of ___________________ , 20 _____ , the undersigned lien claimant, ___________________________________ , furnished or supplied labor, materials, or laborers to ____________________________________ for the purpose of improvements of real property at _________________________________________________________________ , such that the undersigned lien claimant is entitled to a lien for the value of labor, materials, or laborers supplied. Notice is hereby given that pursuant to Colorado Revised Statute §38-22- 117 the above-mentioned lien claimant does hereby assign the lien claimant’s claim and lien to ___________________________________ , who shall hereafter have all the rights and remedies under law to which the lien claimant is entitled for the purpose of filing and for the enforcement of the above-mentioned lien. This the _____ day of _______________ , 20 _____ . ___________________ Company Name ____________________________________ Signature Print Name: ___________________ Title: ___________________ Attest: Secretary Assignment of Lien Page 1 of 2 STATE OF COLORADO COUNTY OF _____________________ The foregoing instrument was acknowledged before me this _____ day of __________, 20____ by ___________________________(name of officer or agent, title of officer or agent) of ___________________________(name of corporation acknowledging) a __________________ (state or place of incorporation) corporation, on behalf of the corporation. ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________ Secretary Assignment of Lien Page 2 of 2