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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 May
12, 2012, at Book 766, Page 514, as Document No. 959235 on property owned by Cecil
and Eva Dabel and affecting the lands described as:
County of Lincoln, State of Wyoming
Beginning at a point which is 1 1 /2 rods East and 5 rods North from the
Southwest corner of Lot 4, Block 21 of the Afton Townsite and running
thence East 8 1 /2 rods; thence North 5 rods; thence West 8 1 /2 rods; thence
South 5 rods, to the place of beginning, being rectangular part of said Lot 4,
Block 21, Lincoln County, 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 Cecil and Eva Dabel has an interest.
IN WITNESS WHEREOF, I do hereunder set my hand this (/ay of
September, 2012.
STATE OF WYOMING
COUNTY OF LARAMIE
ss.
WITNESS my hand and official seal.
My Commission expires: 3 ltd, g 5
State of Wyoming,
D- •admen
w_e1.141 40
S eila McInerney
Its: TPL /Recovery Coordinator
This Release of Verified Lien Statement consisting of i- pages was subscribed,
sworn to and acknowledged before me on this tk"'' day of September, 2012 by Sheila
McInerney as TPL /Recovery Coordinator of the Wyoming Depa ent of Health, Division
of Healthcare Financing.
1
RBARA A. ROLL!
COUNTY OF
LARAMIE
COMMISSION EXPIRES
'U '2
RECEIVED 10/1/2012 at 2:59 PM
RECEIVING 967161
BOOK: 795 PAGE: 324
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY