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Donna A. Murray
Senior Assistant Attorney General
123 State Capitol
Cheyenne, WY 82002
RELEASE 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
February 2, 2012 as Document No. 963116 on property owned by Frances Gordes and
affecting the lands described as:
County of Lincoln, State of Wyoming
A 1/3 interest in that part of Lot 4 of Block 6 of the Town of Kemmerer described as
follows: Beginning at a point 100 feet Southerly from the Northwest corner of said
Block 6 and running thence Southerly on Cedar Avenue 40 feet; thence Easterly
140 feet; thence Northerly 40 feet; thence Westerly 140 feet to the point of
beginning, together with all improvements situate thereon and all easements and
appurtenances belonging thereto.
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 Frances Gordes has an interest.
IN WITNESS WHEREOF, I do hereunder set my hand this 5 day of August,
2012.
STATE OF WYOMING
ss.
COUNTY OF LARAMIE
WITNESS my hand and official seal.
RECEIVED 8/9/2012 at 9:53 AM
RECEIVING 966011
BOOK: 791 PAGE: 133
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
My Commission expires: 11
State of Wyoming,
Departmmof Healt
By: Regina Cox
Its: Quality Assurance Ma ger
00133
This Release of Verified Lien Statement consisting of one page was subscribed,
sworn to and acknowledged before me on this 3 day of August, 2012 by Regina Cox,
Quality Assurance Manager of the Wyoming Department of Health, Division of Healthcare
Financing.
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