Fill and Sign the Colorado Satisfaction Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: _____________________ Company: _____________________ Address: _____________________ City: _____________________ State: ______ Zip: _________ Phone: ___________________ Fax: _______________________ ACKNOWLEDGEMENT OF SATISFACTION—INDIVIDUAL (Colorado Revised Statute § 38-22-118) On or about the _____ of ______________ , 20 _____ , a lien statement was filed by the undersigned regarding improvements made to the property at ______________________________________________________________________ , and attesting to a lien in the amount of $ _______________ . The undersigned hereby provides notice that the above-mentioned lien has been satisfied by payment in full of said lien amount, together with the costs of filing and recording such lien. This the _____ day of _________________ , 20 _____ . _________________________ Signature _____ ____________________ Print or Type Name Acknowledgement of Satisfaction 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: _____________________ CO § 38-22-118 Acknowledgement of Satisfaction Page 2 of 2