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COMES NOW, Timberline Associates, LLC, a Wyoming limited liability company, by and
through its undersigned managing member Rex A. Doornbos, whose address is P.O. Box 3638
Alpine, Wyoming 83128, does hereby make the following statement of facts:
1. That Timberline Associates, LLC is the owner of the land described under the Certificate of
Surveyor on the plat titled, "TETON CROSSINGS, A SUBDIVISION IDENTICAL WITH
LOT 88 ALPINE VILLAGE SUBDIVISION NO. 1 PLAT 2 AMENDED 9 111 FILING
WITHIN SW1 /4SE1 /4 SE1 /4NW1 /4 SECTION 19 T37N R118W LINCOLN COUNTY,
WYOMING dated 4 November 2010, as revised and recorded concurrently herewith.
2. That Rex A. Doornbos has reviewed said plat.
3. That he has read and understands the provisions of the Certificate of Owner thereon and the
implications thereof.
4. That this certificate is signed in the stead of and has the same effect as if the original mylar
of said plat had been signed.
DATED this 2 e day of
Timberline AAsso ates, LLC
'Rex A. Doornbos, Managing Member
STATE OF WYOMING
COUNTY OF LINCOLN
The foregoing instrument was acknowledged before me by Rex A. Doornbos, managing
m ber of Timbe line Associates, LLC, a Wyoming limited liability company, this
day o y 2011.
Witness my hand
otar
\Commi lion xpire
CERTIFICATE OF OWNER'S SIGNATURE
e 1.
SS.
2011.
RECEIVED 2/2/2011 at 10:15 AM
RECEIVING 957892
BOOK: 761 PAGE: 676
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
JAYANTHI J. ROTH NOTARY PUBLIC
COUNTY OF ^j� STATE OF
LINCOLN `,'':19 WYOMING
MY COMMISSION EXPIRES MARCH 31, 2013