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000868
STATE OF WYOMING
AFFIDAVIT OF SA TISF ACTION OF INDEBTEDNESS
AND OF RELEASE OF ASSIGNMENT
RECEIVED 5/5/2006 at 11 :15 AM
RECEIVING # 918078
BOOK: 618 PAGE: 868
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
COUNTY OF TETON
Before me, ~g , the undersigned Notary Public, on this day
personally appeared Daniel V. Buchan, who being by me duly sworn, upon oath says:
That by an assignment dated June 11, 2002, Policy No. AA3066684 issued by
SAFECO Life Insurance Company on the life of William W. Hadley was transferred to
THE JACKSON STATE BANK & TRUST as security for indebtedness.
That the full indebtedness for which said policy was so assigned as security has
been fully paid to the holder of the debt and all interest in said insurance policy by virtue
of the assignment has been released.
That this affidavit is given for the purpose of enabling William W. Hadley to
y hereafter engage in transactions concerning the subject insurance policy without regards
for the subject assignment thereof.
THE JACK~ON STATE BANK & TRUST
qy~C(~~
''{J'amel V. Buchan ' "-
Its Vice President
Subscribed and sworn to me before this 1 st day of May, 2006, to certify which
witness my hand and seal of office.
KATHY LYONS NOTARY PUBLIC
COUNTY OF . STATE OF
TETON WYOMING
Commløloll res 21,2009
Not~taJ d¡;
Jackson, Wyoming
My Commission expires
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