Fill and Sign the Co Llc 497299943 Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ______________________ Company: _____________________ Address: _____________________ City: ___________________ State: _____ Zip: __________ Phone: _____________________ Fax: _______________________ ACKNOWLEDGEMENT OF SATISFACTION—CORPORATION or LLC (Colorado Revised Statute § 38-22-118) On or about the _____ of ______________ , 20 _____ , a lien statement was filed by the undersigned representative of ____________________________________ , a _________________________________ , corporation, regarding improvements made to the property at ___________________________________________________________________ , and attesting to a lien in the amount of $ _________ . The undersigned hereby provides notice that the above-mentioned lien has been satisfied by payment in full of said lien amount, together with the costs of filing and recording such lien. This the _____ day of _______________ , 20 _____ . ____________________________________ Name of Company By: __________________________ ______ _ _____ Signature Title ____________________________________ Type or Print Name Attest: Secretary Acknowledgement of Satisfaction 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: _____________________ CO § 38-22-118 Acknowledgement of Satisfaction Page 2 of 2