HomeMy WebLinkAbout949625Prepared by, recording requested by
and return to:
Name: Trej r-_fs/d
Company: &:--(,ig0A, 'vAMPa 14`
Address:'//off .5'• Zlfulu 3N''
City: lj?.,I~e_
State: 4/y zip: 3307
Phone:, J0;-- fez)- 0~
Fax:
® 329
RECEIVED 9/22/2009 at 12:21 PM
RECEIVING # 949625
BOOK: 732 PAGE: 329
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
---------------------Above this Line for Official Use
LIEN STATEMENT -INDIVIDUAL
(Wyo. Stat. §29-2-106)
COMES NOW, Er 'cXg, .,~)yrs Li'. , as a party who has
performed work or fu,~ishe materials for the improvement of the property located at and
described as~^i&.,, flij
and wobld state as follows:
I . The undersigned began providing labor and/or materials under contract for the
above-described property on the _ day of -Ce b , 206.
2. Work was substantially completed or the contract to furnish materials was
substantially completed on or about the. /6- day of 20/5,9.
3. The undersigned has furnished the following labor and/or materials:
Laborl Materials Date _ _ J/CostlValue
4. The undersi ned hery claims a lien against the above described property in the
amount of $
,.al' M-5--
This the c,20 day of 20,/).
(L/ -
S' nature
1-11 -
STATE OF WYOMING
COUNTY OF L -N c C-~, `
Sworn and subscribed to before me under oath this the 26 * day of
r' , 20dfl , by Sa.re c.~ i~r<<k Sow
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.
A C-,
Notary Public
My Commission Expires:
~e - t"7- za 13
(SEAL)
um a EN 4 N N w g(~
COUNTY OF STATE OF
UNCOLN 0 WYOMING
W COMMSSION F MOM JUNE 17 2013
WY § 29-2-106