1 Rev. 5/21/2018 STATE OF COUNTY OF 1 NOTICE OF LIEN ON REAL PROPERTY U.S. District Court Case # Name of Applicable Party 1. Information about the Property Owner: Name: Email Address: Street Address: City: State: Zip Code: Phone #: Mailing Address, if different: Street Address: City: State: Zip Code: 2. Information about the Claimant/Beneficiary: Name: Clerk of Court, United States District Court, District of Colorado Street Address: 901 19th Street, Denver, Colorado 80294 Phone #: (303) 844-3433, Option 0 3. This lien is claimed against the real property described as and located at: Property Description (e.g. 223Lot 66, Block 1,205224): Street Address: City: State: Zip Code: 4. This lien is in the amount of $ 5. Information: This lien must be recorded with the county clerk and the recorder in the county where the property is located before release of the defendant. The signature of the property owner on this Notice of Lien must be notarized. The receipt confirming the recording of the Notice of Lien must be provided to the U.S. District Court for filing in the U.S. District Court case identified above. The bond release hearing shall be scheduled after the receipt confirming the county222s recording of the property lien has been filed. 6. I declare under penalty of perjury that the foregoing is true and correct. (See 28 U.S.C. 247 1746.) Executed on (date): Signature of Property Owner County Recording Stamp/Seal: 1 This form is provided as a courtesy for our defendants. Some county courthouses may require recording of their own Notice of Lien form, so it is recommended that the property owner and counsel inquire about the county222s preference before using this form. Subscribed and affirmed before me in the county of , State of Colorado, this day of , 20. (Notary222s official signature) (Commission Expiration) Notary Seal American LegalNet, Inc. www.FormsWorkFlow.com