Chapter 19 - EXHIBIT 19E • MECHANICS' LIEN CLAIMANT'S NOTICE TO DISBURSER

• Jurisdiction: Colorado

EXHIBIT 19E • MECHANICS' LIEN CLAIMANT'S NOTICE TO DISBURSER MECHANICS' LIEN CLAIMANT'S NOTICE TO DISBURSER Section 38-22-126(4) and (5), Colorado Revised Statutes

To: Disburser' s Name:

Address:

Pursuant to Section 38-22-126, Colorado Revised Statutes, notice is hereby given that the undersigned is entitled to a mechanics' lien for labor, laborers, materials, services, machinery, tools, equipment, or fixtures furnished for improvements to real property.

1. The land to be improved is situate in the __________ * County of __________, State of Colorado, and is described:

Legal description Address

2. The name, address and telephone number of the lien claimant are:

Name Address Telephone

3 . The name, address and telephone number of the person with whom the lien claimant has contracted are:

Name Address Telephone

4. A general statement of the contract of the lien claimant is:

5. The amount requested by the lien claimant is: $__________.**

__________
Lien Claimant

By __________

*Insert "City and" when applicable.

**This information is optional.

Disburser hereby acknowledges due service of this notice this __________ day of __________, 20__________.

__________
Disburser

By__________

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