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STATEMENT OF LIEN
RECEIVED 10/3/2007 at 11: 18 AM
RECEIVING # 933688
BOOK: 674 PAGE: 291
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
STATE OF WYOMING
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00029j.
COUNTY OF LINCOLN
I, Jason Lindsey a Wyoming Individual, being first duly sworn, hereby state as follow:
1. I Jason Lindsey, located at P.O. Box 3231, Alpine, WY 83128 and is the entity hereby
seeking enforcement of this Lien against Lot #26 Shadow Dancer Subdivision.
2. That under the terms and conditions of material and labor Purchase Order between
Just Stone, a Wyo Corporation and Shadow Dancer Estates, a Wyo Corporation and its
assignee Michael and Carla Kibbie. Deanna Blanchard and Just Stone owes to Jason
Lindsey, the amount of Fourteen Thousand nine hundred and forty seven dollars and
fifty cents ($14,947.50) plus interest @ 15% fifteen percent per annum, starting April
1, 2007 as late.
3. That the last known address of Just Stone and Deanna Blanchard is P.O. Box 13491,
Jackson, WY 83002.
4. That said debt is owned because of Just Stone & Deanna Blanchard's obligation under
it Purchase Order to provide tile installation to Michael Kibbie and Carla Kibbie's
home located in Shadow Dancer Subdivision, Alpine, WY. Ie. Failure to pay for labor
and materials provided in its behalf.
5. That the name of the person(s) against whom this lien is claimed is Just Stone and
Deanna Blanchard..
6. That this Lien is for the Un-paid work and materials provided to Just Stone and
Deanna Blanchard by Jason Lindsey and for which is due and owing Jason Lindsey.
7. That the legal description of the property benefited by the services of Shadow Dancer
Owners Association is Plat # 173C, Lot 26, filed @ Lincoln County, Wyoming.
Dated this ~day of I D
,2(7(77.
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SUBSCRIBED AND SWORN TO. AND ACKNOWLEDGED before me by Jason
Lindsey, who acknowledged further that he is entitled to payment, and that he signed the
foregoing STATEMENT OF LIEN, this -DL day of p~~007.
Witness my hand and official seal.
My Commission expires: 't / 'b-I ) { 0
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SHEILA D. HUNSAKER - NOTARY PUBLIC
COUNTY OF ,.' . '. STATE OF
LINCOLN " WYOMING
MY COMMISSION EXPIRES ~ _
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