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RECEIVED 3/24/2009 at 9:48 AM
RECEIVING # 946089
BOOK: 718 PAGE: 513
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
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Above Space Reserved for Recording
ë I~i ;;; j"~f' 'L.'i;~'me · 'dd'l of: 1) where to reMn this form; 2) prep'rer; 3) p,rty req",~ing recording.j
............................................................................................................................................................
Date of this Document:
Reference Number of Any Related Documents: ~r¡ 4-2
3 - ;.l:7 .- ocr
Lienholder:
-;
Name
Street Address
City/State/Zip
Property Owner:
Name ~Å¡vds \-6.r)l1l f;
Street Address )fi: ~
City/State/Zip, ~. )) \j~ <6?lQ~
~
Abbreviated Legal
condo name): .
Assessor's Property Tax Parcel/Account Number(s}:
..........................................................................................................................................................,..
State of: 'N (.,( 11 Wi 'i Il ':1
County of: I ~ ¡.... U) k1l"\
Before me, the undersigned Notary Public, personally appeared t.~ (ì ':> L -i w; "S
(Lienor) who duly sworn says thathe/she is (the Lienor herein) (the agent of the Lienor herein) whfse address is
5 S N· l-k~n-lJ.....'-e,(,'\ ~.' vJ' , .... $V) rt~b ~54 6 and that in i
accordance with a contract with 0, t-V'\. 4c...y- v-f S (Debtor) lienor I,
furnished labor, services or màterials consisting of (describe specially fabricated materials separately):
WWW.SOI
@20
IF\.
ia.llC
J5
owned
, ' of a
Dollars ($ of which there
Dollars ($ , and
\"f\ô0v¡ 0 ï . 20 and the last of the items on
, 2~J, and (if the lien is claimed by one not in privity with the Owner) that the
lienop~~~.~or hfr notice. ~o{Owner on . 20-,
by~ (YldAJ/
(method of service).
And, (if required) that the lienor served copies of the notice on the contract on
20-, by
on the subcontractor on 20-, by
(method of service) and (if known) on the lender, on
by
(method of service), and
,20
(method of service).
Signed this .¿f-, ';.7 da~ of (VlC<.v-c. h, ,20 D4.
"2 ìl~cZ \A.. I VI. v ~S~vct'..s '. ' "-
lienor: ~, ·~CtV\<:e.J .:rV''5'''--\Cot..-h~ DßPr C k VI-~ l€W i '5
By (offICer or Agent): ~_ VIA~'t" \ CJ UJV'-V\...
State of: fA) '1 OW'! '; J1 (;{
County of: _ L~ "'- C-D I h
On YV1CLr-c.:h Ç)3rd dOð~ ,beforeme,J'i.JJõ\'c:ch ~~u.)el. h ,
appeared c.. k rì ~ ~e.-t.,J ~ ":::. . 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 executéd 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.
Affi a fit Known-':::::Þroduced ID
Type of ID J'J). Dr1lju's ~ f <'1 ~
(Seal)
~ .!'.....d~:"-.--..~ "h"~·""I¡'·':¡:-·;'~"'·'''V'\'~'·~''''·'~,¡o·~;.;J'''''''~·~.9'<Iot~ !'&..\.~~-::,~~ ,
~' . DEBORAH ,,:Ci-IW,l\,8 . NOTARY PUBLIC
1 County of State of
Lincoln Wyoming
,_ __My Commission EXPIr~S July 21, 2010
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