HomeMy WebLinkAbout947751RECORDING REQUESTED BY
EL DORADO COUNTY DEPARTMENT
OF CHILD SUPPORT SERVICES
COUNTY CODE: 0601700
WHEN RECORDED MAIL TO
EL DORADO COUNTY DEPARTMENT OF
CHILD SUPPORT SERVICES
3057 BRIW RD STE B
PLACERVILLE CA 95667-5321
RECEIVED 6/15/2009 at 11:36 AM
RECEIVING # 947751
BOOK: 725 PAGE: 349
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
x: 0v49
SPACE ABOVE THIS LINE RESERVED FOR RECORDER'S USE
DOCUMENT TITLE
NOTICE OF LIEN
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address):
ORecording requested by and return to:
FOR RECORDER'S USE ONLY
DAVID L. BURNS, ATTORNEY
EL DORADO COUNTY
3057 BRIW RD STE B
PO BOX 391 0170056111-01
PLACERVILLE CA 95667-5321
TELEPHONE NO.: (866) 901.3212 FAX NO. (Optional): (530) 621-2022
0 ATTORNEY FOR = JUDGMENT CREDITOR ® ASSIGNEE OF RECORD -
SUPERIOR COURT OF CALIFORNIA, COUNTY OF EL DORADO
STREET ADDRESS: 495 MAIN ST
MAILING ADDRESS: 495 MAIN ST
CITY AND ZIP CODE: PLACERVILLE 95667-5628
BRANCH NAME: PLACERVILLE BRANCH
PETITIONER/PLANTIFF: STATE OF WYOMING EX REL, CRYSTAL ANN
TEAGUE MINOR CHILD
RESPONDENT/DEFENDANT: ADAM ALLEN CORNISH AND JODIE LAMOINE
TEAGUE
OTHER PARENT:
NOTICE OF LIEN
CASE NUMBER:
PFS20060413
COUNTY RECORDER TRANSMITTAL STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
DCSS 0635 (08120/08) DEPARTMENT OF CHILD SUPPORT SERVICES
LEGAL SUPP
NOTICE OF LIEN
TO:
LINCOLN COUNTY CLERK'S OFFICE
925 Sage Ave, Suite 101 (First F] oor) , Kemmerer WY 83101
Obligor:
ADAM A CORNISH, 01/11/1974,566-67-7336
3154 HAZEL ST, POLLOCK PINES CA 95726-9722
FROM:
EL DORADO COUNTY DEPT. OF CHILD SUPPORT SERVICES
PO BOX 391, PLACERVILLE CA 95667-0391
(866) 901-3212, dcss@co.el-dorado.ca.us, (530) 621-2022
Obligee:
JODI L AMOS
IV-D Case 0170056111-01
This lien results from a child support order, entered on 08/24/1994 by SUPERIOR COURT OF
CALIFORNIA in EL DORADO tribunal number PFS20060413.
As of 04/30/2009 , the obligor owes unpaid support in the amount of $27,784.42
This judgment may be subject to interest.
Prospective amounts of child support, not paid when due, are judgments that are added to the lien
amount. This lien attaches to all non-exempt real and/or personal property of the above-named
obligor which is located or existing within the State/county of filing, including any property
specifically described below.
Specific description of property:
Page 1 of 3
All aspects of this lien, including its priority and enforcement, are governed by the law of the
State where the property is located. An obligor must follow the laws and procedures of the State
where the property is located or recorded. An obligor may also contact the entity sending the
lien. This lien remains in effect until released or withdrawn by the obligee or in accordance with
the laws of the State where the property is located.
Note to Lien Recorder: Please provide the sender with a copy of the filed lien, containing
the recording information, at the address provided above.
Check either "A" or `B below. The option that does not apply may be omitted from the form.
If "B" i7Submitted ckedthe form must be notarized.
A. by a IV-D agency/office on behalf of the named obligee
As an authorized agent of a State or Tribal, or subdivision of a State or Tribal, agency
responsible for implementing the child support enforcement program set forth in Title IV, Part D,
of the Federal Social Security Act (42 U.S.C. 651 et seq.), I have authority to file this child
support lien in any State, or U.S. Territory. For additional information regarding this lien,
including the pay-off amount, please contact the a rized agency and reference its case
number, both listed above.
04/29/2009
Date
ERESE
Print name, e-mail address, phone and fax number
B. [ ] Submitted by an obligee or a private (non-IV-D) attorney or entity on behalf of an
obligee
I am [ ] the obligee of the above referenced order [or]
[ ] an attorney or entity representing the above named obligee
I certify under penalty of perjury that the information contained in this notice is true and accurate
and that this lien is submitted in accordance with the laws of the State of
For additional information regarding this lien, including the pay-off amount, please contact the
obligee listed above.
Date Signature
Print name, e-mail address, phone and fax number
Page 2 of 3
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT 00V` 3 52
State of California
County of C.I
On VZ) d-7 before me,
r
Date Here Insert Name and Title f the Officer
personally appeared
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to
be the person(*whose namL, s is/afa, subscribed to the
within instrument and acknowledged to me that
fiNshe/thtW executed the same in hii, her/ftk authorized
SUSAN L, DEGUARA
capacity(i*, and that by NsLher/the signature(s) on the
COMM. #1718868 mm
NotwyPubG WANornla
instrument the erso
p nom, or the entity upon behalf of
W EL DORADO COMY
which the personfs~acted, executed the instrument.
My cam EV. Feb 14,21(1111
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph is
true and correct.
WITNESS my hand and offic
al seal.
i
Signature
Place Notary Seal Above
Signature of Nota y Public
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document:
/C,7Z (2vC
~
Document Date:
~
Number of Pages:
Signer(s) Other Than Named Above:
27i4-
Capacity(ies) Claimed by Signer(s)
Signer's Name:
Signer's Name:
❑ Individual
❑ Individual
❑ Corporate Officer - Title(s):
❑ Corporate Officer - Title(s):
❑ Partner - ❑ Limited ❑ General
❑ Partner - ❑ Limited ❑ General
❑ Attorney in Fact •
❑ Attorney in Fact 8
❑ Trustee Top of
thumb here ❑ Trustee Top of thumb here
❑ Guardian or Conservator
❑ Guardian or Conservator
❑ Other:
❑ Other:
Signer Is Representing:
Signer Is Representing:
C2007 National Notary Association- 9350 De Soto Ave., PO. Box 2402 • Chatsworth, CA 91313-2402- www.NationalNotary.org Item #5907 Reorder: Call Toll-Free 1-800-876-6827