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HomeMy WebLinkAbout91110400.I. 49 Recording Requested By And when recorded mail to: Name Streel Address City State Zip L RECEIVED 8/22/2005 at 11:39 AM RECEIVING # 911104 BOOK: $95 PAGE: 149 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, VVY Space above this line for recorder's use QUITCLAIM DEED (N~I¢t grantor(s)) the undersigned grantor(s), for a valuable consideration, receipt of which is hereby acknowledged, do hereby remise, release, convey and forever quit claim to ~P~ ~- ~~'~. ~~- , (Na~ el gr~mee(~)) all interest in the following described real properly situated in the County, of ~ I~D/~ , State of ~Om~ ~ ~' AUTOGRAPH at "~_~,,~, gO y o~ ~/¢.~7 / - t (c~ty and state) AUTOGRAPH Mail Tax Statement to: Wolco~s Fo~s, our resellers and agen]s make no mpres'entations or warranty, express or implied, as to the fitness of t6i'~ form for any specific use or purpose. If you have any question, it is always best to consult a qualifig~ before using this or any legal document. DOCUMENTARY TRANSFER TAX $ [] computed on tull value of property conveyed, or [] computed on full value less liens and encumbrances remaining at time of sale. Autograph of Declarant or A§ent Determining Tax Firm Name ©2004 WOLCOTrS FORMS, INC. II IIIIIIIIII IIII/11111 , .,.. .'i";;i!!!i~i~i!;ii!; CLASS 03 #7~0 REV 1 04 091110 Individual STATE OF ~,.~ ~ } COUNTY OF - ~~,-~_~ $$. 05 pn_this C~ day of~ in the yea,~/~ , before me, ~ ~¢,,~ IJ -- , a Notary Public, duly corr~fission(~d ~_nd qualified in above said County and State, personally appeared ~'~. ~ , ~ personally known to me or [3.Rroved to me on this basis of satisfactory evidence consisting of an identifying document or [3 the oath of to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(les), and that by his/her/their signature(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the same. WITNESS my hand and official seal. AUTOGRAPH 00. ,50 (Seal) Corporate or Partnership STATE OF COUNTY OF SS. On this __ day of in the year , before me, , a Notary Public, duly commissioned and qualified in above said County and State, personally appeared , ~3 personally known to me or C3 proved to me on this basis of satisfactory evidence consisting of an identifying document or CI the oath of to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(les), as , and that by his/her/their signature(s) on the instrument on behalf of organized under the laws of , executed the same. WITNESS my hand and official seal. AUTOGRAPH (Seal)