Fill and Sign the Limited Liability Company 497299936 Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: _______________________ Company: ____________________ Address: _____________________ City: __________________________ State: _____ Zip: __________ Phone: ______________________ Fax: ______________________ TERMINATION OF NOTICE OF LIEN—Corporation or LLC (Colorado Revised Statute § 38-22-109(11)) Comes now, ____________________________________ , as ___________________ of __________________________________ , a ________________________________ business entity, whose address is _____________________________________________________________________ , and would hereby provide notice of the following: 1. On or about the _____ of __________________ , 20 _____ , the corporation filed a Notice of Lien Claim regarding improvements on property at ___________________________________________________________ . 2. Improvements were undertaken as a result of an agreement between the corporation and the property owner, _____________________________________ . 3. The agreement to provide labor, laborers, or materials for said improvements has terminated. 4. The corporation may not have not performed labor or supplied materials or laborers to all properties belonging to the above-mentioned owner. Properties upon which labor has not been performed or materials or laborers supplied include: ____________________________________________________________ ___________________________________________________________ . 5. This notice hereby specifically terminates only the notice of lien claim filed on the _____ day of ________________ , 20 _____ , in _______________ County, Colorado, regarding the property at ___________________________________________________________ , and is not intended to apply to other liens filed on other properties of the owner. This the _____ day of __________________ , 20 _____ . Termination of Notice of Lien Page 1 of 2 ________________________ Name of Corporation By: __________________________ ______ _ _____ Signature Title ________________________ Type or Print Name Attest: Secretary STATE OF COLORADO COUNTY OF _____________________ The foregoing instrument was acknowledged before me this _____ day of __________, 20____ by ___________________________(name of officer or agent, title of officer or agent) of ___________________________(name of corporation acknowledging) a __________________ (state or place of incorporation) corporation, on behalf of the corporation. ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________ CO § 38-22-109(11) Termination of Notice of Lien Page 2 of 2