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When Recorded Return to:
E & S Legal Services, llC
Post Office Box 3029
Cheyenne, VVY 82003
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00041.9
RELEASE OF VERIFIED LIEN STATEMENT
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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 5/16/2005, in Book
585, Page 311, as Document No. 908413 on property owned by Virginia B. Elmlinger and affecting
the lands described as:
County of Lincoln, State of Wyoming
The Lots numbered Twelve (12), Thirteen (13) and Fourteen (14) of the Block
Numbered Eleven (11) in the Town of Diamondville, Lincoln County, Wyoming, as
surveyed, platted and recorded, together with all improvements and appurtenances
thereon.
Subject, however, to all reservations, easements and rights-of-way of record.
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.
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
Virginia B. Elmlinger has an interest. .
IN WITNESS WHEREOF, I do hereunder set my hand this~ay of October, 2006.
RECEIVED 11/6/2006 at 3:46 PM
RECEIVING # 924117
BOOK: 639 PAGE: 419
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
STATE OF WYOMING )
) ss.
COUNTY OF LARAMIE )
The foregoing
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WITNESS my hand and official seal.
State of Wyoming,
artment of Health
By: Debbie Paiz
Its: Recovery Manager
instrument was acknowledged before
thi~ (¡u day of October, 2006.
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me
by
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