Fill and Sign the Colorado Individual Form 497299955

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- INDIVIDUAL (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 his or her 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 _____ . _________________________ Signature _____ ____________________ Print or Type Name Assignment of Lien Page 1 of 2 State of Colorado County of _________________ The foregoing instrument was acknowledged before me this the ___ day of ____________________________, 20___, by _________________________________________ (name of person acknowledged). ______________________________ Notary Public ______________________________ Print Name My Commission Expires: ____________________ Assignment of Lien Page 2 of 2