Notice of Intent to Lien Form


Notice To:

[______]   Property Owner




Sent to Property Owner Via Certified Mail No:


[______]   Prime Contractor




Sent to Prime Contractor Via Certified Mail No:


Name and Mailing Address of Party Providing Notice (“Noticing Party”):



Description of Services or Materials Provided by Noticing Party:



Total Amount Owed to Notifying Party (“Debt”):


Address Where Materials Delivered (“Property”):




A Statement of Lien is attached to this Notice, wherein the Noticing Party claims a mechanics lien for the materials, equipment, labor and/or services above - described, performed on a construction project at the Property.

This notice is provided to you in accordance with C.R.S. §§ 38 - 22 - 109(3). If payment is not made to the Noticing Party within ten (10) days, the Noticing Party intends to record the attached Statement of Lien in the appropriate county ’ s recording office.


Agent for Noticing Party

Signed by


Identification of Parties:

Noticing Party:



Hereinafter (“Claimant”)





[_____]   Property Owner:




[_____]   Prime Contractor:




I, __________________________, declare that on the _____ day of _____________, 20____, pursuant to Section 38 - 22 - 109(3) C.R.S. , I served copies of the Notice of Intent to the following parties above identified:

[_____]   Property Owner

[_____]   Prime Contractor

I served the Notice of Intent to Lien:

[_____]   By personally delivering the notice to the identified parties;

[_____]   By First Class Certified or Registered Mail service, postage prepaid, with return receipt requested, add ressed to the party at the above - identified address, which is the last known address of the Property Owner and/or Prime Contractor.

I declare under penalty of perjury that the foregoing is true and correct.

Sworn to and subscribed before me, Not ary Public for the State of _______________ and Parish / County of ________________, on this ____ day of ____________, 20____.




Signed by:

Prepared By and Return To:






CRS §§ 38-22-109

The Claimant: (Name & Address)




The Property Owner: (Name & Address)




The Prime Contractor: (Name & Address) (If Claimant is the Pri me Contractor, Just Write “ the Claimant. ” If the Claimant is not a Prime Contractor, the Statement of Lien must identify the Prime Contractor)




The Propertyto be charged with Lien:

Municipal Address:



Legal / Other Description:



County of

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 liene d is above - identified as the Property Owner;
  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 labo r or services, or supplied the machinery, tools or equipment, for which this lien is claimed. The Claimant is a:

    [_____] Prime Contractor

    [_____] Subcontractor

    [_____] Supplier

    [_____] Laborer

    [_____] Other _______________________________

  1. 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.

  2. If the Claimant is not the Prime Contractor, the Prime C ontractor has been above - identified as the “ Prime Contractor. ”

  3. 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.


Executed on the ____ day of __________________, 20____



I, ________________________, being of lawful age and being first duly sworn upon oath, I am a disclosed agent of the Claimant named herein, appointed for the express purposes of signing this statement of lien; that I have read the statement of lien and know the contents thereof; that to the best of my knowledge, information and be lief, the same is true and correct, and made on behalf of the Claimant.

Agent of Claimant

Signed by

Sworn to and subscribed before me, undersigned Notary Public, on this ____ day of _______________, 20____.

Notary Public

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