Fill and Sign the Release of Lien Pursuant to Notice of Bond 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: _______________________ RELEASE OF LIEN PURSUANT TO BOND (Colorado Revised Statute §38-22-129(4)) Whereas, on or about the _____ , of ______________ , 20 _____ , a lien statement was filed by ____________________________________ regarding improvements to real property at ____________________________________________________________________ , and Notice is hereby given that on or about the _____ , of _____________ , 20 _____ , the undersigned Principal Contractor and Corporate Surety executed a bond for said improvements in the amount of $ ___________________ , and that the above-mentioned lien claimant is entitled to the benefits of said bond. Further, that pursuant to C.R.S. §38-22-129(4) upon the filing of this notice, the above-mentioned lien is hereby deemed released. This the _____ day of _______________ , 20 _____ . ________________________ Signature of Principal _____ ___________________ Print or Type Name ________________________ Signature of Surety _____ ___________________ Print or Type Name Release of Lien Pursuant to Bond 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 § 38-22-129(4) Release of Lien Pursuant to Bond Page 2 of 2