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RECEIVED 8/15/2007 at 4:42 PM
RECEIVING # 932169
BOOK: 668 PAGE: 878
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
L
J
000878
Above Space Reserved for Recording
[If required by your jurisdiction. list above the name & address of: 1) where to return this form; 2) preparer; 3) party requesting recording.]
Claim of Lien
............................................................................................................................................................
Date of this Document: A {J (Ç /'5j J-cx:J 7
Réference Number of Any Related Doëuments:
h
'¡ Lienholder:
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Name
Street Address
City/State/Zip
Property Owner:
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.ß(rbJAJ to /¡.../SON qt G-úJ PI/IN! 'Y- tv~L.L0J¡f!/uN6-LZÀ)c,Q
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Name
Street Address
City/State/Zip
?OS' &¡OIZCI.¡.,. J<(?".¡(}L EST1C7e OE~.t::7·
5"'6 F. -{1 " 7ó~/1)~ J 2--1-;1 PLoD/¿
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5'¡;¡¿T' t:.A~p él7C(1 Uf/J/t/.. ~4I)S-O
Abbreviated Legal Description (i.e" lot, block, plat, or section, township, range, quarter/quarter or unit, building and
condo name): /(4 A.)(,';,e/( q G T)" .ø r~ S- A L.L 8 ó:ç 4ó /
f30crJ "Yf'.R V~Cß)TÐ? ALLPC:C 'T;z( ~/~, ,523
( r:"t?-'VeQ/'0t¿ co-R ,4,1 /31'<,4/2.1..( J /.3,;(;:.2::2' ) ,/ ,¡B,qGt¿ 3.L1 Ó
Assessor's ·Property Tax Parcel/Account Number(s): ót116,;1..3 /:¿f éJ.-.9 ¿JOO
.............................................................................................................................................................
State of:
County of:
úJ1ðM;;AJ6->
h <' A.;('"nI AI
Before me, the undersigned Notary Public, personally appeared I/, &Ie../lN wi tsðr\l
(Lienor) who duly sworn says that he/she is (the Lienor herein) (the agent of the Lienor herein) whose address is
"7 '3~9 /l,LUI ú.J1J '1 CøHnJ.l'lñ-~ II~../,·(f'l.r ,VI. FL//P-} and that in
accordance with a contract with L.oJ c/{(,MJ.,cH '¡:::,M.;~'¡'o/' RAtúJ.Q/2.P CL5Ndi, (Debtor) lienor
furnished labor, services or materials consisting of (describe specially fabricated materials separately):
ÆE/'lAJ5~ /;.¡/'f- IJr {".t:J~.W~"~....Jl /N (!#olù:ß. :' ¿..1(jR..t}.(?1 . /lM7'¡;;1?../4i..S
t'"/:;JT~~ J {:L&<k~ t>F'r/ t:..(P I Sï:J<F: Þ.d'-E~/o 6\1Tr' ~h"'¡ (,ÆN7«24-
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@ 2005 Socrates Media, llC
lF13G-! . Rev. 02/05
000B79
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on the follo~ng describ~d real property in .L/ ¡t...c-{)/ Ai County, State of
V~ðlIVAJ~ (Describe real property sufficiently for identification, including
street and number): A~./ /"J,o e. --I- ~ ~/.) iUES'( .L) ~ .
K~AÆ-k/] F~ / td<¡6YYb/^G--
I
èÆß~J5r. ¡:. . owned
by (,l/rVJC~ ()I= LAí7M¿JLJL¡ £,.(}/;..;¡-¡)' \Á.£)S) of a
total value of-akeÍ'k:osA:~ 1\1¡.uJtv~~~j)ollars ($ '> / c¡ ~3', 00 ) of which there
remains unpaid . Dollars ($ ":3 , 9qS-; 06 ), and
furnished the first of the items on --i7l!./~ ~ , 20 ö '7 . and the last of the items on
/11.,¡q't, I;)' . 2012...1-, ahlÖfthe lien is claimed by one not in privity with the Owner) that the
lienor served his or her notice to Owner on A.a.e )/ . .200'( .
by /ÅJ .ðe,^,,~/P\J ANV C..öJJIÁs fÂ<pf?cI-fz, LLJs: [fi'v¡¿c.#. ¡t::M W'T' &7:>-l5UP
~~thod of.se~ice). (-ët:J(,~ Ç'P/Li.A.Jj\f 'f Á.03 (:#<.)/2.0::'; óFr~G-e, ~~J. S'¿C) ß/'..:.,!./J,'\) :~
l!!1....- ~o7-~'l~-696q) /
And, (if required) that the lienor served copies of the notice on the contract on
20_____, by .
on the subcontractor on
(method of service) and (if known) on the lender, on
by
Signed this -- (f +~ day of /!C)(S-US''{
Lienor: --;;¡¡:. ak.a-V ~MJ
(method of service), and
20-, by
,20
(method of service).
,2°4.
By (officer or Agent):
State of: \,1 )'t6ff\ \'()3
County of: \ \(\('(} \n
On ,5 , before me, :)w().X\f\o.. l:-\:\l\.).Jl<€-3 ,
appeared ' personally known to me (or proved'
to me on the basis of sa isfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within
instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies),
and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the
person(s) acted, executed the instrument.
..'
WITNESS my hand and official seal.
~JruV\C\'\11-;j, fuw~ a~
Signature of Notary
. SAVANNA L. HAWKES - NOTARY PUBLIC
Affiant KnownY... ProducedlD
Type of 1õ"1)"\!i'f;-t(. Ü,t\S-e. ( Ul)
(Seal)
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@ 2005 Socrates Media, llC
If 136-1 . Rev. 02/05