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RECEIVED 6/15/2007 at 11 :04 AM
RECEIVING # 930374
BOOK: 662 PAGE: 121
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
STATE OF WYOMING )
) SS.
COUNTY OF LINCOL?'f )
COMES NOW Madeleine Micbde Gaf;en, whose address is 15440 N 71sr Street,
Scottsdale, Arizona 85254, and being duly sworn on oath acC;.r,rdiJ\g to aw, does hereby l11.ak~
the following statements oftàcts and af.tlm:1s:
1. That she is an owner of the lard dcscrih:d uude-r tho(: CertH"j.cate ,:-if Surveyor on the plat
t't1 'd ",t-\ L'~)INF ':[1 r ~\GE S"! TI'DJvI"J01," NTO' 1 PLA":-'~ ^MlT,NrDED _ .,TH F"'L" n..:G'
.1 e, . ~ ! .I...... ,J ....':1 _ D, . . ð. _ ., ~.,. ... ,_ /'\.. ft ~ J j 11"t
IDENTICAL WJTH LOT 69 ALPINE \/1LLAGE SUBDrVIS~pN NO. 1 PLAT 3
AME.~DED '"VrTIllN SE% SECTION 1!j T37N R 118\V I~lNCOLN COL'NTY,
WYOMING". dated 22 Marc·.J¡ 2007, .ai; revised.
2. That the undersigned has reviewed. said p]at.
3. TIlat the' unders.igned ha,s read and unde:s!::tr'ds th,; P¡\)Üsη:ms of tb~[~ Certificaw of Owner
thereon and 'the implications therc:of.
4. That this affi.ctavit îssigned in the stoad of and ha;;. die sanje eft(~ct ~: ifd:e originall11)'lar üf
said plat had been signed.
DATED this 2J day Of~_, 2()()'.
Madeleine Michele Gagen
B)':
2?k~}7ú~0 ~
Madeleine Michele Gagen
The foregoing ìnstnnnent 'was ac.knowI~dg~d before me by Madeleine h ~chele Gag~m, on this.
7-:) dny of 4 Pf;£'=-_> 2007. ' I
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KARL F. SCHERB~L - NÒ' RY PUBLIC
County of State of
Lincoln 1 Wyoming
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Witness my hand and official seaL
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Notary l~
Corn.!nission Expires: 9-14'1- 2ð7J1{
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