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Prepared by, recording requested by
and return to:
Name: Jã rel ;E'r ¡'C lú(.?/!
Company: 15 r,'c. /fso/t pÚ{tJpTlJf:i lÃ'
Address: (JO ¡joK 'Ill{
City: 7110",/ If (;,
State: IA.jl{ Zip: 8.3 IJ '1
Phone: 3D/-, 8'ð1J - ¡Y'f!:>-
Fax:
RECEIVED 10/30/2007 at 11 :02 AM
RECEIVING # 934449
BOOK: 677 PAGE: 223
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER. WY
000223
----------------------Above this Line for Official Use Onl ____m______________
LIEN STATEMENT -INDIVIDUAL
(Wyo. Stat. §29-2-106)
COMES NOW, E;<./(so,'1 EX(¿/luA. TZJfS I;,~. , as a party who has
performed work or furnished materials for the improvement of the property located at and
deSCribedasfi~ t?'~;¿r; ,)-5' =tHY c;~ '~ ST'Mf/l ¿a..rI'r
L/Ab f&m._ L _' iAT~~fTheC__t:.-___r _____ ,
and would state as follows: .
1. The undersigned began providing labor and/or materials under contract for the
above-described property on the ~ day of Jiw e- , 20.t2.L.
2. Work was substantially completed or the contract to furnish materials was
substantially completed on or about the .:30 day of <T¿ ,20!2.L.
3. The undersigned has furnished the following labor and/or materials:
Labor/Materia/s ~a~ Cost/Va/ue'tS
P,K?du¿£r-]{}/I ~ ~ 'lJ7 -I~ 6;'(
4. The undersigned hereby claims a lien against the above described property in the
amount of $ ,3 (P:L '1- ttB. .
This the /? day of 0" Tn ~if
, 20 () 1.
cf~ ~L_
~ature
STATE OF WYOMING
~
COUNTY OF"'· ~J
000224
//J ~w.?m and subscribed to before me under oathjhis the
~ ,20~by
who acknowledges that the matters and things alleg in the fo
true and correct to the best of his knowledge as therein stated.
N~r
My Commission Expires:
(SEAL)
7-/5-01
WY § 29-2-106
JOAN JENSEN - NOTARV PUBUC
. STATE OF
COUNTY OF WYOMING
UNCO'-H -1,"-0'1
" MYCOMt.1ISSI0~ EXPIRE~? -'