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C00.471
STATE OF WYOMING
)
) SS.
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AFFIDA VTT
RECEIVED 11/2/2005 at 12:24 PM
RECEIVING # 913373
BOOK: 603 PAGE: 471
JEANNE WAGNER
_-=/NCOLN COUNTY CLERK, KEMMERER, WY
COUNTY OF LINCOLN
COMES NOW, Raymond S, Petersen and Sons, Inc. whose address is P,O. Box 212, Cokeville,
Wyoming 83114 acting through it's President, Richard D. Petersen, who being duly sworn on
oath according to law, does hereby make the following statements of facts and affirms:
1. That Raymond S. Petersen and Sons, Inc. is the owner of the land described under the
Certificate of Surveyor on the plat titled, "SMITH'S FORK SUBDNSION II PART OF
TRACT 78 T25N R118W LINCOLN COUNTY, WYOMING", dated 28 September 2005,
as revised.
2. That the undersigned has reviewed said plat.
3. That the undersigned has read and understands the provisions of the Certificate of Owner
thereon and the implications thereof.
4. That this affidavit is signed in the stead of and has the same effect as if the original mylar of
said plat had been signed.
DATED this I'U day of Novemh"v- 2005.
RAYMOND S. PETERSEN AND SONS, INC
Attest:
/J .;t-/ t?~/~ // ~!- ~ C) C--
~b, peterseri../'" P"'
President
On this ls;l day oftVovelhJ..-e.-V"', 2005, before me personally appeared Richard D. Petersen, by me
first duly sworn, who did say that he is the President of, and that the seal affixed to this
instrument is the corporate seal of Robert S. Petersen and Sons, Inc, and that this instrument was
signed and sealed on behalf of said corporation by authority of its Board of Directors and
acknowledged said instrument to be the free act and deed of said corporation.
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Notary Public ~
My Commission Expires: to -:z()~ 7
Brenda J. azcanotegul. Notary Public
County of State of
Lincoln Wyoming
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My CommissIon Explr.. -
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