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STATEMENT OF LIEN
STATE OF WYOMING
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COUNTY OF LINCOLN
I, Sharon L. Backus, Manager for Star Valley Ranch Association, Inc., a
Wyoming Corporation, being first duly sworn, he~eby state as follows:
1. Star Valley Ranch Association, Inc., is located at 781 Vista Drive, P.O.
Box 159 Thayne, WY 83127 and is the entity hereby seeking enforcement of this Lien.
2. That under the provisions of the Declaration of Covenants, Conditions and
Restrictions of the Star Valley Ranch Subdivision and the Association ("the Declaration)
Derek Thompson owes to Star Valley Ranch Association, Inc., the amount of Five
Hundred Twenty Two Dollars and Eighty-Three Cents ($522.83).
3. That the last known address of Derek Thompson is 1630 Cottage Lane
Apt. #29 Spearfish, SD 57783.
4. That said debt is owed because of Derek Thompson's obligation under the
Declaration of Covenants, Conditions and Restrictions of the Star Valley Ranch
Subdivision and the Association.
5. That the name of the person(s) against whom this Lien is claimed is:
Derek Thompson.
6. That this Lien is for the Association Dues due and owing to Star Valley
Ranch Association, Inc. for the year of 2005.
7. That the legal description of the property benefited by the services of Star
Valley Ranch Association, Inc. is: Plat 5 Lot 83.
8. That a copy of the instrument creating the obligation is attached as
EXHIBIT A.
DATED this 1fictay of October, 2005.
RECEIVED 10/20/2005 at 10:38 AM
RECEIVING # 912975
BOOK: 601 PAGE: 864
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
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Sharon Backus, Manager
Star Valley Ranch Association, Inc.
Statement of Lien
Page 1 of2
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SUBSCRIBED AND SWORN TO, AND ACKNOWLEDGED before me by
SHARON BACKUS, who acknowledged further that she is the Manager of Star Valley
Ranch Association, Inc., and that she signed the foregoing STATEMENT OF LIEN for
and on behalf of Star Valley Ranch Association, Inc. pursuant to the authority given to
her by said Corporation's Board of Directors, this ìt"Lday of October, 2005.
WITNESS my hand and official seal.
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NOTARY PUBLIC ~
My Commission expires: 0 S -tj-, -1.00,
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Statement of Lien
Page 2 of2
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