JDF 109 R 3 /1 8 AFFIDAVIT TO SUPPORT CLAIM FOR A BREACH OF THE WARRANTY OF HABITABILITY Page 1 of 2 County Court County, Colorado Court Address: Plaintiff(s): v. Defendant(s): COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Numb er: Atty. Reg. #: Case Number: Division Courtroom AFFIDAVIT TO SUPPORT CLAIM FOR A BREACH OF THE WARRANTY OF HABITABILITY PURSUANT 247 38 - 12 - 507(1)(c) C.R.S. The Defendant(s) answers(s) the C omplaint stating that the Landlord has breached the warranty of habitability. In addition, to the answer filed, I/we file this A ffidavit stating the following: The rental agreement , which is the subject of this action , was enter ed into or extended or renewed on or after September 1, 2008. Total Past Rent Due , as stated in the Complaint: $ Total expenses incurred as a result of the property being unin habitable: $ Differ ence (Total Past Rent Due minus total expenses incurred ) $ NOTE: If the t otal rent due is greater than the total expenses incurred as a result of the property being uninhabitable , you are required to deposit funds in the Court Registry f or the amount stated above. This money must be deposited via certified funds with the Court at the same time you are filing your answer. This money will be held in the Court Registry and refunded or applied as ordered by the C ourt at the conclusion of th e case . American LegalNet, Inc. www.FormsWorkFlow.com JDF 109 R 3 /1 8 AFFIDAVIT TO SUPPORT CLAIM FOR A BREACH OF THE WARRANTY OF HABITABILITY Page 2 of 2 By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form. VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the day of , , at (date) (month) (year) (city or other location, and state OR country (Printed name of Defend a nt) Signature of Defend a nt I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the day of , , at (date) (month) (year) (city or other location, and state OR countr y (Printed name of Co - Defend a nt) Signature of Co - Defend a nt CERTIFICATE OF SERVICE I ce rtify that on (date) a true and accurate copy of this AFFIDAVIT TO SUPPORT CLAIM FOR A BREACH OF THE WARRANTY OF HABITABILITY PURSUANT TO 247 38 - 12 - 507(1)(c), C.R.S ., was served on the other party (s) or attorney (s) by: Hand Delivery E - filed Faxed to this number or by placing it in the United States mail, postage pre - paid, and addressed to the following: Signature American LegalNet, Inc. www.FormsWorkFlow.com