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STATEMENT OF LIEN
RECEIVED 7/9/2007 at 3:54 PM
RECEIVING # 931057
BOOK: 664 PAGE: 1:!x:::>
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
STATE OF WYOMING
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000830
COUNTY OF LINCOLN
I, F. Michael Kibbie, Vice President for Shadow Dancer Owner Association, Inc., a Wyoming
Corporation, being fIrst duly sworn, hereby state as follow:
1. Shadow Dancer Owner Association, Inc., is located at 1195 Trail Ridge Road, (South
of Alpine), P,O. Box 3207, Alpine, WY 83128 and is the entity hereby seeking
enforcement of this Lien against Lot # 3 Shadow Dancer Subdivision.
2. That under the provisions of the Declaration of Covenants, Conditions and
Restrictions of Shadow Dancer Estates and Shadow Dancer Owners Association ("The
Declaration) recorded by the Lincoln County Clerk August 11, 2004, CCT
Investment LLC % Chris Tice, owes to Shadow Dancer Owner Association, the
amount of Eight Hundred and fIfty dollars and no cents ($800.00 dues and $50.00 Late
fee plus interest @ 15% fIfteen percent annum, starting Dec. 15,2006 as late).
3. That the last known address of CCT Investment LLC % Chris Tice is P. O. Box
4824, Jackson, Wyoming, 83001.
4. That said debt is owned because of CCT Investment LLC % Chris Tice obligation
under Article IV Covenant for Maintenance Assessments (1.) Creation of the lien and
Personal Obligation of Assessments obligation under the Declaration of Covenants,
Conditions and Restrictions of the Shadow Dancer Owners Association.
S, That the name of the person(s) against whom this lien is claimed is CCT Investment
LLC % Chris Tice,
6. That this Lien is for the Association Dues due and owing to Shadow Dancer Owners
Association for the year of2007.
7. That the legal description of the property benefIted by the services of Shadow Dancer
Owners Association is Plat #173C, Lot #3, frIed @ Lincoln County, Wyoming.
8. That a copy of the instrument creating the obligation has been fIled with the Lincoln
County Recorder Book 564n PR Page 488,901863,489 to 503.
Dated this 26 day of June, 2007.
, Michael Kibbie, Vice President
Shadow Dancer Owner Association
SUBSCRIBED AND SWORN TO, AND ACKNOWLEDGED before me by F.
Michael Kibbie, Vice President, who acknowledged further that he is the Vice President of
Shadow Dancer Owners Association, and that he signed the foregoing STATEMENT OF LIEN
for and on behalf of Shadow Dancer Owner Association, pursuant to the authority given to him by
said Corporations' Board of Directors, this 26 day of June, 2007.
Witness my hand and official seal.
My Commission eXPiI:es~t.I;'" 5. åJ/ /
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