Fill and Sign the Colorado Individual Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ____________________ Company: _________________ Address: _____________________ City: _____________________ State: _____ Zip: __________ Phone: ____________________ Fax: ______________________ MEMORANDUM OF CONTRACT—INDIVIDUAL (Colorado Revised Statute §38-22-101(3)) State of Colorado County of ________________ BE IT KNOW THAT ____________________________________ , "Owner(s)", whose address is _______________________________________________________________ , files this Notice pursuant to Colorado Revised Statutes, Section 38-22-101(3) and would state in support thereof the following: 1. Notice is hereby given that Owner(s) has entered into a contract with the following parties (contractor): _______________________________________________________________________ for the purpose of commencing work on the following property: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ A description sufficient for identification of the real property to be improved. The description should include the legal description of the property and also should include the street address of the property if available or, if there is no street address available, such additional information as will describe the physical location of the real property to be improved.] 2. A general description of the improvements to be made are: ________________________________________________________________________ Memorandum of Contract Page 1 of 3 ________________________________________________________________________ ________________________________________________________________________ 3. The parties to the above-mentioned contract estimate the total amount to be paid under said contract to be $ ___________________ . 4. Pursuant to the contract between the parties payments will be made on the following dates or stages of completion of work: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ _________________________________________________________ . 5. A copy of the contract ( ) is ( ) is not attached to this Notice. THIS the _____ day of ____________________ , 20 _____ . Owner(s) ____________________________________ Signature Print Name: _____ ____________________ ____________________________________ Signature Print Name: _____ ____________________ STATE OF COLORADO COUNTY OF ____________________ The foregoing instrument was acknowledged before me this _____________________ (date) by ________________________________ (name of person acknowledged.) ______________________________ Notary Public Printed Name: _________________ ______________________ Title/ rank ______________________ Serial Number Memorandum of Contract Page 2 of 3 Memorandum of Contract Page 3 of 3