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AFFIDA VIT
0004ï'3
STATE OF ~
COUNTY OF enrMrrae
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) SS.
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COMES NOW, the Mortensen Family Trust, dated 19 September 2000, acting through its
Trustee whose address is 6225 Smith Avenue Baltimore, MD 21209-3600, being duly sworn on
oath according to law, does hereby make the following statements of facts and affirms:
I. That the Mortensen Family Trust, dated 19 September 2000 is an owner of the land
described under the Certificate of Surveyor on the plat titled, "DOUBLE L RANCH WEST
SUBDIVISION WITHIN GLO LOT 4 SECTION 21 GLO LOT 1 GLO LOT 2 GLO LOT 3
WY2Nm'4 NY2SE~ SECTION 28 T36N R119W LINCOLN COUNTY, WYOMING", dated
25 May 2006, as revised.
2. That the undersigned has reviewed said plat.
3. That the undersigned has read and understands the provisions of the Certificate of Owners
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 \~day of February 2007.
THE MORTENSEN FAMILY TRUST, DATED 19 SEPTEMBER 2000
~ Attest:
m¡ttH'II,"~.Tru(ifiii ~,4.~
The (~ing instrument was acknowledged before me by Marianne Schmitt Hellauer, Trustee
this ~..) t.J day of February 2007.
Commission Expires