HomeMy WebLinkAbout939001
Claim of Lien
............................................................................................................................................................
~ wl1òYVI9
L I Nc-aL-tV .
000579
State of
County of
Before me, the undersigned Notary Public, personally appeared ~0 V ì s Lewi'<
who duly sworn says that he is (the lienor herein) (the agent of the lienor, herein) whose address is.
®vcu/\ced ~'Sldcch(¡~
and that in accordance with a contract with YVl (C-~ C\. e \ CD Ó. V\l\rCQ. V\
lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials
separately) -.=tv'\. Sl d Dc ~C/Y"\ (')\í\ YtðYV\Q
on the following described real property in t VV\.C...O 11\ L.cï"^-K County,
State of W ~ð\tvl( VI... i
(DeSC{ibe real property su~iciently for identification, including street and number:- .
'DD LDd'^^-Clh. ~PO-~ ~~\~a.. 'if:3 \ '2-1{
S'\I\(~l.Ü ~(C(~- ~ ~- ~--
~ q _ eyC --. LO
Cfþ
owned
of a
C¡ ]0,4,00)
Dollars ($ q ~ 1 q <-II 00),
, 20 () -:} and the last of the
,20 DE> and (if the lien is claimed by one
fY\ a I j /_0 I ' . ,
by
total value of
of which there remains unpaid
and furnished the first of the items on ~ ð-v ').. l
items on ¡IT? 'fi \ LCJ
not in privity with the owner.) that~tþe}enor ~erved his notic,e to owner on
20J2B- by Qe.( -h-H e..-è ()V\(A.. \ \
(Method of Service)
And, (if required) that the lienor served copies of the notice on the contract on
20 ,by
, and on the subcontractor
(Method of Service)
on 20
lender
, by
, and (if known) on the
, on
, by
(Method of Service)
RECEIVED 5/14/2008 at 1 :39 PM
RECEIVING # 939001
BOOK: 694 PAGE: 579
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Page 1
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C 2004, Socrates Media, llC
lF136 . Rev. 04104
000580
Signed this l~-rh
Wi Ci.j
lIe~Or: i~J^f ~
~ fit-
day of
,20 O~ .
By:
Officer or Agent
State of lÙ<QC\ 0\ \ (\5
County of L:\ (\t'<\ \0.
}
On ~c\\ \L\-\~ ,20..œ.....beforeme,~\l(lnntl~\-\iliJ\rf..S.
appeared (~.h (\8 LA IJ\S
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized
capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the
person(s) acted, executed the instrument.
WITNESS my hand and official seal.
~ . -;j ib'J
signaturE('· ìCU1.1..Û- ,Q [J
Signature of Notary
~""~.,Ji"'"~'-'iÞ',,",#,~.'1r~"~~
SAVANNA L. HAWKES" NOTARY PUBLIC
Affiant _Known~Produced ID
TypeoflD ,(\t\'r\~ (~f1Ùe.(") \Ú::!Lf\2>e..
(Seal)
Page 2
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C 2004. Socrates Media, LLC
Lf136 . Rev. 04/04
ADVANCED INSULATION
4755 N HAROLDSEN DRIVE
IDAHO FALLS, ID 83401
FED ID#75-3073741
000581. Invoice
Date Invoice #
1/2/2008 3424
Bill To
CODMAN, MICHAEL
Due Date Project
11127/2007
Description Qty Rate Amount
ALL PREP WORK: MATERIAL & LABOR 8,722,76 8,722,76
WALLS R-22
RIM R-22
BASEMENT WALLS SPRAYED R-30
LID BAFFLED, NEITED & BLOWN FULL
GARAGE WALLS SPRAYED FULL
GARAGE LID R-30
THEATER ROOM WALLS NEITED & SPRAYED FOR SOUND
FLOOR NEITED & BLOWN R-20 1,071.24 1,071.24
Sales Tax 6.00% 0.00
Total $9,794,00
Payments/Credits $0.00
.-
Balance Due $9,794,00
Phone #
Fax#
542-0757 or 716-0757
208-522-5953