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E & S Legal Services, LLC
Post Office Box 3029
Cheyenne, VVY 82003
RECEIVED 4/6/2009 at 4:17 PM
RECEIVING # 946365
BOOK: 719 PAGE: 874
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
00û874
6010917693
When Recorded Return to:
RELEASE OF VERIFIED LIEN STATEMENT
Claimant, State of Wyoming, Department of Health, Office of Medicaid located at 6101
Yellowstone Road, Suite 210, Cheyenne, Wyoming 82002, hereby releases the VERIFIED LIEN
STATEMENT FOR LIEN FOR MEDICAL ASSISTANCE which was recorded on 8/18/2008, in
Book 702, Page 524, as Document No. 941357 on property owned by Ann Hansen and affecting
the lands described as:
County of Lincoln, State of Wyoming
Lot Seven (7) of Block Fifty-four (54) of Second Addition to the Town of Kemmerer, Lincoln
County, Wyoming as described on the official plat thereof together with all improvements situate
thereon and all easements and appurtenances belonging thereto. .
The above described lien is fully released as to the above-described real property, but
Claimant expressly retains and reserves the right to satisfy the remaining debt due and owing
Claimant from any and all other available assets.
Notwithstanding any other provision in this Release of Verified Lien Statement, Claimant
is not releasing or waiving any rights it has or may have to satisfy the remaining unpaid debt
from any and all other assets, including past, present, and future assets, owned by or in which
the Estate of Ann Hansen has an interest.
IN WITNESS WHEREOF, I do hereunder set my hand this ~ay of March, 2009.
By: Sheila Mcinerney
Its: Recovery Manager
STATE OF WYOMING )
) ss.
COUNTY OF LARAMIE )
This instrument was acknowledged before me on \ 0 day of March, 2009 by Sheila
Mcinerney as Recovery Manger of the Wyoming Department of Health, Office of Health Care
Financing.
WITNESS my hand and official seal.
.I.:~~~VY~:?::.;"'::..~~
CYNTHIA K. WORKMAN - NOTARY PUBLIC ¡'
COUNTY OF STATE OF 2
LARAMIE WYOMING '!;
~~
MY COMMISSION EXPI~'
(~~\llì"!A'/ l,) Q\J~1.A~
N~t8ry Public
My Commission expires: Ll· /'6' m
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