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COUNTY OF LINCOLN
COMES NOW Bradford G. Martin and Kimberly Ann Martin, husband and wife, who, being
duly sworn on oath according to law, do hereby makes the following statements of facts and
affirm:
1. That they are owners of part of the lands depicted on the map titled, "MOOSE
HOLLOW SECOND FILING INCLUDING PART OF LOT 2 OF MOOSE HOLLOW
SUBDIVISION AND PART OF GLO TRACTS 72 AND 74 WITHIN THE N1 /2
SECTION 12 T21N R116W LINCOLN COUNTY, WYOMING as revised.
2. That they have reviewed said map.
3. That they have read and understand the provisions of the Certificate of Owners thereon
and the implications thereof.
4. That this affidavit is signed in the stead of and has the same effect as if the original
mylar of said map had been signed.
DATED this 3O day of 114 rc I-, 2010.
Le--4
Bradford O. Martin
The foregoing instrument was acknowledged before me by Bradford G. Martin and Kimberly
Ann Martin, this &j day of (fi 2010.
Witness my hand and official seal.
CERTIFICATE OF SIGNATURE
SCOTTSARUENT
COUNTY OF
STATE OF
LINCOLN ��H:�::,«v,• WYOMING
My Commission Exoires JP!
My commission expires: 07- e0 /Q
RECEIVED 4/15/2010 at 11:17 AM
RECEIVING 952938
BOOK: 745 PAGE: 555
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Kimberl nn Martin
1
Notary Public
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