Fill and Sign the Colorado File Lien Form

NOTICE OF INTENT TO FILE LIEN—Corporation or LLC (Colorado Revised Statute §38-22-109(3)) Notice is hereby given that, ___________________________________ , as ___________________ of _______________________________ , a ____________________________ registered business entity, whose address is ______________________________________________________________________ , ____________________ , Colorado, ___________________ , hereby provides notice that said corporation performed labor, or provided materials or laborers for improvements to the property located at ________________________________________________________________________ and intends to file with the county clerk or recorder a lien statement regarding the above mentioned property and improvements ten (10) days from the date of service of this notice. This the _____ day of _____________________ , 20 _____ . _________________________________________ Name of Company By: __________________________ ______ _ _____ Signature Title ____________________________________ Type or Print Name 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 ___________________________, who is the owner/owner's agent located at ______________________________________ and the principal or prime contractor/agent located at _______________________________. So certified this the ______ day of ___________________, 20____. ________________________ Signature Notice of Intent to File Lien Page 1 of 1