Statement of Mechanics Lien Form (for GCs)

IInstrument Prepared By
And Recording Requested By:











Space Above For Recorderʼs Use

Statement of Lien

CRS §§ 38-22-109

Claimant: (Name and Address)





Property Owner: (Name and Address)





The Property to be charged with the lien:


Municipal Address:



Legal Property Description:





State of Colorado

The CLAIMANT avails itself of the provisions of CRS § 38-22-109 by filing this Statement of Lien.

1. The name and address of the owner of the property being liened is above-identified as the Property Owner;


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2. The name and address of the person making this Statement of Lien and claiming this lien is above-identified as the Claimant. The Claimant is the party who actually furnished the material or performed the labor or services, or supplied the machinery, tools or equipment for which this lien is claimed. The Claimant contracted directly with the above-identified Owner.

3. The Property being charged with the lien is above-described as the Property. The labor, materials, services, and/or equipment furnished by the Claimant has been incorporated into the Property.

4. The indebtedness due and owing to the Claimant for said labor, materials, services and/or equipment is $___________, as of the date this Statement of Lien is recorded.

5. The labor, materials, services and/or equipment furnished by the Claimant is described as follows:

Signature of Claimant, and Verification

State of

County of

I, ___________________, the undersigned, being of lawful age and being first duly sworn upon oath, do state that I am the Claimant named herein, or an authorized agent of the Claimant appointed for the purposes of signing and filing this Notice of Claim of Lien, and that I have read the foregoing Notice of Claim of Lien, know the contents thereof, and I have been provided and thereby have knowledge of the facts, and certify that based thereupon, upon my information and belief the foregoing is true and correct, and that I believe them to be true.



Signed by



Sworn to and subscribed before me, undersigned Notary Public, on this date: __________________

Notary Public




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