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Prepared by, recording requested by
and return to:
Name: X~eJ £rit:..&1l _
Company: b/~A E:racJamf'5 Me.
Address: Ie? ~~ flY
City: ~C.I .2
State: . tJ( Zip: ð.3/Jr
Phone: 301- f{l)- 8frs-
Fax:
RECEIVED 8/18/2008 at 11 :59 AM
RECEIVING # 941358
BOOK: 702 PAGE: 526
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
ûO~J52G
----------------------Abovethis Line for Official Use Onl ____________nm____
LIEN STATEMENT -INDIVIDUAL
(Wyo. Stat. §29-2-106)
, as a party who has
ropert located at and
1. The undersigned began providing labor and/or materials under contract for the
above-described property on the --L day of .J W1 ¿.. , 20(J l-.
2. Work was substantially completed or the contract to furnish materials was
substantially completed on or about the IS day of ~v , 20~.
3. The undersigned has furnished the following labor and/or materials:
Labor/Materials Date ~ C0i.lValue
5~dd77Ù_", ;1lY/0 ::JaJfi> :4 '11 ð(
4. The undersigned hereby claims a lien against the above described property in the
amount of $ 41.31, ð I .
Thisthe /1( day of ¥
,2~.
(lJ ~~
~gnature
STATE OF WYOMING
COUNTY OF kIt\, (...0/ '"
~>00527
Sworn and subscribed to before me under oath this the /~ day of
A.'-\.1 "".1) r- , 20~ by .::f"'-fLd tN ...1<3 ù.,
who acknowledges that the matters and things alleged in the foregoing Lien Claim are
true and correct to the best of his knowledge as therein stated.
1;g~ f3~
Notary Pubh
My Commission Expires:
(SEAL)
_......,..~........._~--_....].
MARGE BÀLLš- - NOTARY PUBLIC .
COUNTY OF ~ STATE OF
LINCOLN ., WYOMING
[~~~~:;~,,2!).'~
I'Y\.¡ )..5, J. Q~ 0
WY § 29-2-106