Fill and Sign the Notice of Nonresponsibility by Individual Colorado Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name:       Company:       Address:       City:       State:       Zip:       Phone:       Fax:       NOTICE OF NON-RESPONSIBILITY--Individual (Colorado Revised Statute §38-22-105(2)) Notice is hereby given that _____________________________________ , owner having obtained notice of erection, construction, alteration, repair, or other improvement on the property located at ________________________________________ , hereby notices all parties engaged in performing labor, or providing materials or laborers, that any interest held by __________________________ in said property will not be subject to a lien for said erection, construction, alteration, removal, addition, repair, or other improvement. This the ____ day of ___________________ , 20 ____ .       Signature of Owner       Type or Print Name Notice of Non-Responsibility Page 1 of 2 STATE OF COLORADO COUNTY OF _____________________ The foregoing instrument was acknowledged before me this ____ day of ___________________ , 20 ____ by ___________________________ _(name of person acknowledged) . ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________ Certificate of Delivery I, _____________________________________ , hereby certify that I have delivered this day a true and correct copy of the foregoing to _________________________________ by: Personal Service So certified this ____ day of ___________________ , 20 ____ . ______________________________ Signature CO § 38-22-105(2) Notice of Non-Responsibility Page 2 of 2