HomeMy WebLinkAbout964293RELEASE OF VERIFIED LIEN STATEMENT
Claimant, State of Wyoming, Department of Health, Office of Medicaid located at 2300
Capitol Avenue, Room 147, Cheyenne, Wyoming 82002, hereby releases the VERIFIED
LIEN STATEMENT FOR LIEN FOR MEDICAL ASSISTANCE which was recorded on 6 -7-
2010, at Book 748, Page 520, as Document No. 953846 on property owned by Dorthea
Jiacoletti and affecting the lands described as:
County of Lincoln, State of Wyoming
Lot 11 of Block 45 of the Second Addition to the Town of Kemmerer, Lincoln
County, Wyoming as described on the official plat thereof.
ALSO, the Northerly 4 feet, 2 inches of Lot 10 of Block 45 of the Second Addition to
the Town of Kemmerer, Lincoln County, Wyoming more particularly described by
metes and bounds as follows:
BEGINNING at the Northeasterly corner of said Lot 10 and running thence
Southerly along the Easterly boundary of said Lot, a distance of 4 feet, 2 inches;
thence Westerly, parallel with the Northerly and Southerly boundaries of said Lot
10, a distance of 125 feet to the Westerly boundary of said Lot; thence Northerly 4
feet, 2 inches, to the Northwesterly corner of said Lot; thence Easterly, 125 feet to
the Northeasterly corner of said Lot, the PLACE OF BEGINNING together with all
improvements situate thereon and all easements and appurtenances belonging
thereto.
Note to Clerk: Please Do Not put recording Information Above this Line.
When Recorded
Return to:
E S Legal Services, LLC
Post Office Box 3029
Cheyenne, WY 82003
The above described lien is fully released as to the above described real property,
but Claimant expressly retains and reserves the right to satisfy the remaining debt due and
owing Claimant from any and all other available assets.
Notwithstanding any other provision in this Release of Verified Lien Statement,
Claimant is not releasing or waiving any rights it has or may have to satisfy the remaining
unpaid debt from any and all other assets, including past, present, and future assets,
owned by or in which the Estate of Dorthea Jiacoletti has an interest.
IN WITNESS WHEREOF, I do hereunder set my hand this day of
2012.
STATE OF WYOMING
ss.
COUNTY OF LARAMIE
This instrument was acknowledged before me on this f�. day of
2012 by Sheila McInerney as TPL /Recovery Coordinator of the Wyoming Departmen
Health, Office of Healthcare Financing.
WITNESS my hand and official seal.
RECEIVED 4/26/2012 at 12:28 PM
RECEIVING 964293
BOOK: 785 PAGE: 266
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
My Commission expires: L
State of Wyoming,
Department of Health
t3y: Sheila McInerney r%
Its: TPL /Recovery Coordinator
Notary Fru,I lic
Please place recording sticker here
00266
of
ShyAnn Rausch Notary Public
County of State of
Laramie n afi)7 Wyoming
My Commission Expires July 5, 2015