HomeMy WebLinkAbout949839Prepared by, recording requested by
and return to:
Name: Jal'eJ Company: Er- A &Ldva~
Address: ql2
City:
,rrv~e.
State: C~ Zip:
Phone: oO - 880- M5_
Fax:
RECEIVED 10/2/2009 at 10:37 AM
RECEIVING # 949839
BOOK: 733 PAGE: 183
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
000IS13
----------------------Above this Line for Official Use
LIEN STATEMENT -INDIVIDUAL
(Wyo. Stat. §29-2-106)
COMES NOW, 9tj,_&4 &,,1w rS _754z , as a party who has
performed wor~ pr furnished jnate ials for the improvement of the propZIA ocated at an
described as AA,4 5(_ r_" t T060 A L,~r,_,-R_ .St IdLen
and would state as follows:
1. The undersigned began prow ding labor an or materials under contract for the
above-described property on the _ day of , 20tO&_.
2. Work was substantially completed or the contract to furnish materials was
substantially completed on or about the. /,5- day of 1 , 20,~?Z.
3. The undersigned has furnished the following labor and/or materials:
Labor/Materials Date CostlValue_ r
4. The undersigned hereby claims a lien against the above described property in the
amount of $
.
This the day of ~C 77-- , 20,1~)
Si afore
STATE OF WYOMING
COUNTY OF
Sworn and subscribed to before me under oath this the day of
20 by rr)
who acknowledges that the matters and things alle d in the fo oing Lien Claim are
true and correct to the best of his knowledge as therein stated.
My Commission Expires:
7-/d -a")/.3
WY" § 29-2-106
.4Y-n--~1
Not Public
(SEAL)
JOAN JENSEN - NOTARY PUBLIC
COUNTY OF STATE OF
LINCOLN WYOWNG
MY COMMISSION EXPIRES