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Prepared by, recording requested by
and return to:
Name: J~ (3r;~A
Company:Er:c.J&>f1 Eip..ct()ttfOf:; J-¡1(.
Addre~ .1'0 ðt9X rlc
City: I ~r.Á¿
State: Æ/l( Zip: 8.Jld7
Phone: 3!J)83/) -JýY$
Fax:
RECEIVED 10/18/2007 at 10:52 AM
RECEIVING # 934156
BOOK: 675 PAGE: 921
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
000921.
----------------------Above this Line for Official Use Onl ____________m______
LIEN STATEMENT -INDIVIDUAL
(Wyo. Stat. §29-2-106)
COMES NOW, E(I~~/1 ~Ca( M/7J{.s :z;,¿ , as a party who has
performed work r furnished materials for the improvement of the property located at and
described as ~. ? .6 lJa .
I. The undersigned began provWng labor and/or materials under contract for the
above-described property on the:l day of .5c.¡7Ú1fJef, 20~.
2. Work was substantially completed or the contract to furnish materials was
substantially completed on or about the -3D day of J;lv , 20e?-.
3. The undersigned has furnished the following labor Indlor materials:
LaborlMaterials . ~a~ JCost/Value
ExCAuäTI'v.,. 1, ~' J . /{ JJ>Jr 33
4. The undersigned hereby claims a lien against the above described property in the
amount of$ /1/'8/,.13 . .'
, ~?
This the /?- day of ¿:2: mhr r , ~ .
a~/4~~-
Sjg1Íature c.----
STATE OF WYOMING .
COUNTY OF ~
000922
/A ..Sw~m and subscribed to before me under oath this the
~ , 20!!.L by
who acknowledges that the matters and things al ged in the foregoing Lien Claim are
true and correct to the best ofms knowledge as therein stated.
~~
Notary lic (/
My Commission Expires:
(SEAL)
7-/~ -09
JOAN JENSEN - NOTARYP'uBUC
èOUNTYOF. STATE OF
UNCOLN WYOMING
MY ÇOM"'ISSIO~ EXP'RE~ '7-1 S -ð e¡
WY § 29-2-106