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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, hereby 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)
Shawn C. & Angelique M. Mallatt owe to Star Valley Ranch Association, Inc., the
amount of Five Hundred Fifty Two Dollars and Sixty Eight Cents ($552.68).
3. That the last known address of Shawn C. & Angelique M. Mallatt is P.O.
Box 7674 Jackson, WY 83002.
4. That said debt is owed because of Shawn C. & Angelîque M. Mallatt'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:
Shawn C. & Angelique M. Mallatt.
6. That this Lien is for the Association Dues due and owing to Star Valley
Ranch Association, Inc. for the year of 2005.
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7. That the legal description of the property benefited by the services of Star
V alley Ranch Association, Inc; is: Plat 18 Lot 149.
8. That a copy of the instrument creating the obligation is attached as
EXHIBIT A.
DATED this 1~ay of October, 2005.
RECEIVED 10/20/2005 at 10:35 AM
RECEIVING # 912969
BOOK: 601 PAGE: 852
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
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Sharon Backus, Manager
Star Valley Ranch Association, Inc.
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Statement of Lien
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0912969
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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 b~half of Sta~ Valley Ranch A.ssociation,. In;.rrsuant to the authority given to
her by said CorporatIOn's Board of Directors, this' day of October, 2005.
WITNESS my hand and official seal.
SUu~~ ~
NOTARY PUBLIC
My Commission expires: 0 6 - Dì . )..0(') 1
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Statement of Lien
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