Fill and Sign the Colorado Revised Statutes Title 38 Property Real and Form

Notice of Labor Performed or Materials Supplied Page 1 of 2 NOTICE OF LABOR PERFORMED OR MATERIALS SUPPLIED- INDIVIDUAL (Colorado Revised Statute Section §38-22-102(4)) TO: [Owner, superintendent of construction, agent, architect, or financial institution] Please take notice that the undersigned has, or has agreed to and will, furnish labor, materials, or laborers to For (Describe type of work) In connection with improvement of the real property located at .The estimated value of labor already performed and materials already supplied is $ .The estimated value of labor to be performed and/or materials to be supplied is $ .Date: ____________________________________ Signature of Lien Claimant Print or Type Name Address of Lien Claimant) Notice of Labor Performed or Materials Supplied Page 2 of 2 Certificate of Delivery I, , hereby certify that I have delivered this day a true and correct copy of the foregoing to by: Personal Service Leaving a copy at his residence or place of business with some person in charge located at . By delivering it to his superintendent of construction/agent/architect, , at . Leaving a copy at the superintendent of construction/agent/architect’s residence or place of business at with some person in charge. By delivering it to the financing institution/person disbursing construction funds, , at . Leaving it either at the place of business of the financing institution or place of business or residence of the person disbursing construction funds at with some person in charge. So certified this the ______ day of ___________________, 20____. ______________________________ Signature CO § 38-22-102(4)