HomeMy WebLinkAbout965290STATE OF WYOMING
ss.
COUNTY OF LINCOLN
1. Name and address of lien claimant:
Hams Fork Construction, LLC
502 Moose Street
Kemmerer, Wyoming 83101
307 877 -5997
LIEN STATEMENT
Pursuant to the provisions of W.S. 29 1 312 relating to lien statements, the undersigned hereby
files this lien statement and swears as follows:
2. The amount claimed to be due and owing: $2,000.00 (original contract totaled $6,611.90), and
attorneys' fees and costs incurred by lien claimant in the collection of this amount.
3. The names and addresses of the persons against whose properties the lien is filed include:
Todd Moores
44065 US Highway 189
Kemmerer, Wyoming 83101
The amounts due and owing from Todd Moores for the work performed and/or materials
provided are set forth in the actual invoices, attached hereto as Exhibit "A
5. The name of the persons whom the lien claimant asserts is /are obligated to pay the debt
secured by the lien: Todd Moores
6. The lien claimant last performed work, or furnished materials, for which the lien claimant
asserts a lien on the May 25, 2012.
RECEIVED 6/27/2012 at 10:25 AM
RECEIVING 965290
BOOK: 788 PAGE: 379
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
003'79
4. An itemized list setting forth and describing the work performed or materials furnished by the
lien claimant is attached hereto.
7. The legal description of the real property where the lien claimant performed work or furnished
materials is as follows: All of the Northwest Quarter of the Southwest Quarter of Section 20, of
the Resurvey of Township 22 North, Range 115 West of the 6th P.M., Lincoln County,
Wyoming lying North of the North right of way boundary of U.S. Highway 189 as described and
recorded in Book 20 of Deeds on Page 194 on file in the office of the Lincoln County Clerk.
LESS AND EXCEPT any land within the Westridge Holdings Subdivision, Lincoln County,
Wyoming filed December 8, 2006 as Instrument no. 925169 of the records of the Lincoln County
Clerk. More commonly known as 44065 US Hwy 189 N, Kemmerer, Wyoming 83101. with a
physical address of 44065 US Highway 189, Kemmerer, Wyoming 83101.
8. A true and accurate copy of the Invoice under which the lien claimant performed work or
furnished materials is attached hereto as Exhibit "A
DATED this 27 of 2012.
Name of Lien Claimant: Hams Fork Construction, LLC
By: Susan Fagnant, representative for the Claimant
Title: ),e
STATE OF WYOMING
ss.
COUNTY OF LINCOLN
On this oZ '7 w4 day of 0 20 4,2 subscribed and sworn to before me personally
appeared Susan Fagnant, agent for Claimant, to me personally known, who has read the
foregoing Lien Statement and knows the contents thereof and the facts are true to the best of
his/her knowledge, and being by me duly sworn, did state that he /she is a Member of Hams Fork
Construction, LLC and that this lien statement was signed and sealed on behalf of the lien
claimant by authority granted to the signatory by the lien claimant.
Witness my hand and official seal.
Notaria ficer
My Commission Expires:
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Seal:
00380
June 20, 2012
To: Todd Moores
U.S. Highway 189 (Willow Springs)
Kemmerer, WY 83101
Hams Fork Construction, LLC
502 Moose Street
Kemmerer, WY 83101
(702) 372 -1274
Invoice
Labor:
Matt Upstairs (30 hours) Downstairs (16 hours) 2,300.00
Derek Upstairs (27.5 hours) Downstairs (14 hours) 1,452.50
Scott Upstairs (25 hours) Downstairs (23 hours) 2,400.00
Dump Fee 80.00
Ace Hardware Supplies 67.07
Home Depot Supplies 312.33
TOTAL: 6,611.90
6/20/2012 Payment Received: 4,611.90
Balance Due: 2,000.00
EX EDIT A
00381