Fill and Sign the Co Llc 497299958 Form

AFFIDAVIT OF LABOR OR MATERIALS FURNSIHED (Colorado Revises Statute §38-22-130(1)) Comes now, ___________________________________ , whose address is _______________________________________________________________________ , and after being duly sworn hereby states as follows: 1. Beginning on or about the _____ of _______________ , 20 _____ , the undersigned Affiant furnished labor or materials in the improvement of the real property located at ___________________________________________________________ . 2. The Affiant undertook to furnish labor and materials for said improvements based upon agreements between the Affiant and principal contractor, __________________________________ , in the value of $ _____________ . 3. Further, the principal contract and his surety ________________________________ , have executed a bond for these improvements subsequent to C.R.S. §38-22-129. 4. The Affiant has not yet been paid the value of the labor or materials provided. 5. Pursuant to C.R.S. §38-22-130 if this affidavit remains uncontroverted by the principal contractor forty-five (45) days after date of service, the surety shall pay to the Affiant the full amount of his claim. This the _____ day of _______________ , 20 _____ . _______________________________________ Signature of Affiant _____ ____________________________________ Print Name of Affiant Affidavit of Labor or Materials Furnished Page 1 of 2 STATE OF COLORADO COUNTY OF _____________________ The foregoing instrument was acknowledged before me this _____________________ (date) by _________________________________________ (name of person acknowledged.) ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________ Certificate of Delivery I, _____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing to ___________________________________ by: ( ) Personal Service ( ) Mailing a true and correct copy of same by registered or certified U.S. mail, postage prepaid, return receipt requested to ___________________________, ( ) Leaving a true and correct copy of same at the recipient’s residence or place of business at ____________________________________________________ with some person in charge. So certified this the ______ day of ___________________, 20____. ________________________ Signature Affidavit of Labor or Materials Furnished Page 2 of 2