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Prepared by, recording requested by
and return to:
Name: J;v·ccß £rJ'LJ6cM
Companyfrlè J&¡f 6Ccw,1l)F:i.JÅ¿c
Addr~: 10 &x 'IlY
City: '/h1.YI!¿"( ~
State: ivY Zip: ~/Jf
Phone:3t>f - 38>0- f'l'lS
Fax:
RECEIVED 10/18/2007 at 10:50 AM
RECEIVING # 934155
BOOK: 675 PAGE: 919
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
0009j.9
--------------m---Above this Line for Official Use On ---------------------
LIEN STATEMENT -INDIVIDUAL
(Wyo. Stat. §29-2-106)
COMES NOW, ,e(/<.IØl>!1 R:cat)¿;,/7r)rJ Lÿ_
performed work or furnished materials for the improvement of the
de~cribed as J. ' d
ú
and would state as fi lows:
, as a party who has
roperty located at and
1. The undersigned began providing labor and/or materials under contract for the
above-described property on the --11- day of I ~ ~. , 2012.L.
2. Work was substantially completed or the contract ~o furnish materials ",:as
substantiallycompletedonoraboutthe ~ day of :Xlv ,200?-.
(
3. The undersigned has furnished the following labor and/or materials:
LaborlMaterials ~ 'II CostlValue
£XLa¡j¿'¡f,¡/N/1 . - (' #tJ ì- 3~)r, Yfl
4. The unders~ned hereby claims a lien against the above described property in the
amount of $ 31a,;¡!i. t¡ 8 .
This the /1 day of Oc.mhð , 20 (il.
OJk~~
Srature
STATE OF WYOMING
COUNTY OF ~
00092,0
a: and subscribed to before me under 08 this the /1~.P day of
..l-v ,2007, by .~
who acknowledges that the matters and things aIle d in the foregoing Lien Claim are
true and correct to the best of his knowledge as therein stated.
NOUUy~ r
My Commission Expires:
(SEAL)
'1 -/5 - tJ9
JOAN JENSEN· NOTARY PUBUC
. .. STATE OF
COUNTY OF WYOMING
LINCOLN 5~()C¡" .
MY COMMISSION EXPIRES '7 -/ .. . .
WY § 29-2-106