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STATEMENT OF LIEN
STATE OF L��/4'j-/
SS.
COUNTY OF �/k,%41r
I, F. Michael Kibbie, Vice President for Shadow Dancer Estates Owners Association, a
Wyoming nonprofit corporation, being first duly sworn, hereby state as follows:
1. Shadow Dancer Estates Owners Association is located at 1195 Trail Ridge Road,
(South of Alpine), P.O. Box 3207, Alpine, WY 83128 and is the entity hereby seeking
enforcement of this Lien against Lot 21 of Shadow Dancer Estates Subdivision,
Lincoln County, Wyoming.
2. That under the provisions of the Declaration of Covenants, Conditions and
Restrictions of Shadow Dancer Estates and Shadow Dancer Estates Owners
Association "The Declaration) recorded by the Lincoln County Clerk August 11,
2004, Lot 21 owes to Shadow Dancer Estates Owners Association, the amount of
Eight Hundred and seventy five dollars and no cents ($825.00 dues and $50.00 Late
fee plus interest 15% fifteen percent annum, starting February 19, 2010 as late).
3. That the last known address of Emmet and Romina Mavy is PO Box 3821, Alpine,
WY 83128.
4. That said debt is owed because of Emmet and Romina Mavy's obligation under
Article IV Covenant for Maintenance Assessments (1.) Creation of the lien and
Personal Obligation of Assessments obligation under the Declaration of Covenants,
Conditions and Restrictions of the Shadow Dancer Estates Owners Association.
5. That the name of the person(s) against whom this lien is claimed is Emmet and
Romina Mavy.
6. That this Lien is for the Association Dues due and owing to Shadow Dancer Estates
Owners Association for the year of 2010.
7. That the legal description of the property benefited by the services of Shadow Dancer
Estates Owners Association is Plat #173C, Lot 21 of Shadow Dancer Estates
Subdivision, Lincoln County, Wyoming.
8. That a copy of the instrument creating the obligation has been filed with the Lincoln
County Recorder, at Book 564PR, Page 488, instrument number 901863.
Dated this Zf' day of March, 2010.
SUBSCRIBED AND SWORN TO, AND ACKNOWLEDGED before me by F.
Michael Kibbie, Vice President, who acknowledged further that he is the Vice President of
Shadow Dancer Estates Owners Association, and that he signed the foregoing STATEMENT OF
LIEN for and on behalf of Shadow Dancer Estates Owners Association, pursuant to the authority
given to him by said Corporations' Board of Directors, this Z-`` day of 40t4, 2010.
Witness my hand and official seal.
My Commission expires:
This Document is being recorded by
Rocky Mountain Title Insurance Agency
of Lincoln County as a COURTESY only
000762
r�. c(1
Michael Kibbie, Vice President
Shadow Dancer Estates Owners Association
DENNIS NOTARY CONGROVE
3121 West Directors Row
Salt Lake City, Utah 84104
My Commission Expires
April 5, 2011
STATE OF UTAH