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When Recorded Return to:
RECEIVED 11/14/2005 at 11 :06 AM
RECEIVING # 913665
BOOK: 604 PAGE: 598
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
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Post Office Box 3029
Cheyenne, VVY 82003
RELEASE OF VERIFIED LIEN STATEMENT
Claimant, State of Wyoming, Department of Health, Office of Medicaid located at
6101 Yellowstone Road, Suite 210, Cheyenne, Wyoming 82002, hereby releases the
VERIFIED LIEN STATEMENT FOR LIEN FOR MEDICAL ASSISTANCE which was
recorded on 12/6/1971, in Book 96 PR, Page 421, as Document No. 434946 on property
owned by Olive Heap and affecting the lands described as:
Section 23, Township 34 No. Range 119 West % ac. Theyne Town
The above described lien is fully released as to the above-described real property,
but Claimant expressly retains and reserves the right to satisfy the remaining debt due and
owing Claimant from any and all other available assets.
L)
Notwithstanding any other provision in this Release of Verified Lien Statement,
Claimant is not releasing or waiving any rights it has or may have to satisfy the remaining
unpaid debt from any and all other assets, including past, present, and future assets,
owned by or in which the Estate of Olive Heap has an interest.
C7l..l¿,-
IN WITNESS WHEREOF, I do hereunder set my hand this r·- day of
November, 2005.
I
-....J
State of Wyoming,
Depart::n! of He~lth (/ ..__~)
c.. _______lb-hLL/ U.:z-^-_J
- y: Debbie Paiz
Its: Recovery Manager
STATE OF WYOMING )
) ss.
COUNTY OF LARAMIE )
The foregoing Release of Verified Lien Statement was subscribed and sworn to
before me by Debbie Paiz this c¡ttk../ day of November, 2005,
My Commission expires: 1./. /3, 00
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~,' CY,ITHIA K. WO:,~,~~~I~',UDTARY PUB Llcl
S; COUNTY OF .,'iÄ, STATE OF ~
~~ L;\fIAMlE ~i "WYOMING ~
MY COMMISSION ~)( IRES 'Wi], 1:1,2009 ~
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