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Prepared by, recording requested by
and return to:
Name: X~c;l Er ,',)rSó/1
Company: E rII...U!ð,II 6."'1w/l)f IÃ(...
Address: /ö ßðX yti
City: ~tJ1¿ " J
State: wf Zip: 8.j1J.
Phone: 301- &80-8'1'1.>
Fax:
RECEIVED 10/30/2007 at 10:58 AM
RECEIVING # 934447
BOOK: 677 PAGE: 219
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
0'00219
"
----------------------Above this Line for Official Use Onl ---------------------
LIEN STATEMENT -INDIVIDUAL
(Wyo. Stat. §29-2-106)
COMES NOW, Er;é..J{s¡M £~ø(þ;tfl1f5 Me. , as a party who has
performed work or furnished materials for the improvement of the roperty located at and
described ~~.'7l e .. C- 8:::;-"/ ~ . u7
and would state as
1. The undersigned began providing labor an<jl...s>r materials under c9ntract for the
above-described property on the Æ day of If¡"'L/ , 2001-.
I
2. Work was substantially completed or the contract to furnish materials was
substantially completed on or about the /0 day of ~/v ,20¿;¿z.
/
3. The undersigned has furnished the following labor and/or materials:
Labo!,/Materials Da~e . j CostlValuet¿
.Ex.t'du ¿oll7ì'{:)/I Jj¡t'lo1éJt)/~ 4- ~ð>D
4. The undersigned ~eby claims a lien against the above described property in the
amountof$ ~/ 99() .
,
This the / '1 day of Ocmbcr ,2001 .
û~1 f4l:~
S~ature
STATE OF WYOMING
COUNTY OF ~~
000220
/f} . ~w~rn and subscribed to before me under oat this the ~9 day of
~l-l.U , 20 tJ 1 , by .
who acknowledges that the matters and things alle d in the foregoing Lien Claim are
true and correct to the best of his knowledge as therein stated.
rr4U
Notary lic
My Commission Expires:
(SEAL)
7- /$'-ð7
WY §29-Z-106
i{A.R~ PUBUC
J.O,..N JENSEN.- NO s1,..,.E Of
. . f vNOtA\NG
cOu~'ci~· .2 '/~
~PIRES
M'i COMMISSION