HomeMy WebLinkAbout950199RECORDING REQUESTED BY
EL DORADO COUNTY DEPARTMENT
OF CHILD SUPPORT SERVICES
RECEIVED 10/26/2009 at 12:17 PM
RECEIVING # 950199
BOOK: 734 PAGE: 521
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
COUNTY CODE: 0601700
WHEN RECORDED MAIL TO
EL DORADO COUNTY DEPARTMENT OF
CHILD SUPPORT SERVICES
3057 BRIW RD STE B
PLACERVILLE CA 95667-5321
O 0521
SPACE ABOVE THIS LINE RESERVED FOR RECORDER'S USE
DOCUMENT TITLE
NOTICE OF LIEN
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address):
FOR RECORDER'S USE ONLY
Recording requested by and return to:
DAVID L. BURNS, ATTORNEY
EL DORADO COUNTY
3057 BRIW RD STE B
0670490337-01
PO BOX 391
PLACERVILLE CA 95667-5321
TELEPHONE NO.: (866) 901-3212 FAX NO. (Optional): (530) 621-2022
a 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: COUNTY OF EL DORADO
RESPONDENT/DEFENDANT: KASEY JACK COY
OTHER PARENT:
CASE NUMBER:
NOTICE OF LIEN
PF2011
COUNTY RECORDER TRANSMITTAL STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
DOSS 0635 (08/20/08) DEPARTMENT OF CHILD SUPPORT SERVICES
PLV TEAM 1
NOTICE OF LIEN
TO: 0CY 5
LINCOLN COUNTY CLERKS OFFICE
925 SAGE AVE. SUITE 101, FIRST FLOOR, KEMMERER WY 83101
Obligor:
KASEY J COY, 01/05/1975, 564-83-2757
88 NIELD AVE, AFTON WY 83110-9774
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:
CHERYL A LESHER
IV-D Case 0670490337-01
This lien results from a child support order, entered on 09/23/1996 by SUPERIOR COURT OF
CALIFORNIA in EL DORADO tribunal number PF2011.
As of 9-30-09 , the obligor owes unpaid support in the amount of $190.80
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:
UNKNOWN
Page 1 of 3
C-0359-3
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" is checked, the form must be notarized.
A. V},%ubmitted 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 authorized agency and reference its case
number, both listed above.
Date thorized Agent
LANETTE OLINGER
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
CERTIFICATE OF ACKNOWLEDGMENT
State of California County of L m &Jn )
On I L301 t-' )c) me r1w'e. j-. I ob M, C"
Date (here insert name and title of t officer)
personally appeared LA-U1~I' , z
Name' of Signer'
who proved to me on the basis of satisfactory evidence to be
the person W whose name ~'is/~ subscribed to the within
instrument and acknowledged to me that>e/she/tK6y executed
the same in I"/her/tl r authorized capacity and that by
1*/her/trr signature (0 on the instrument the person W,
or the entity upon behalf of which the person S,s') acted,
executed the instrument.
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 official seal.
VALERIE LADOWSKI
COMM. #1861457 ~n
W Notary PubliaCOVOMIN
EL DORADO COUNTY
,My Comm. Ex p. AUG 16 2013
Signature Place Notary Seal Above
Signature of Notary Public