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7. Legal description of the premises where the materials were
furnished or upon which the work was performed:
825 Saddle Drive; Nordic Ranches IV Lot 53, T36 R119 S26, Lincoln
County, Wyoming, being 1.66 acres more or less.
Bowers Law Office P.C.
106 Hospital Lane
P.O. Box 1550
Afton, Wyoming 83110
(307) 885.0640
547
Subject to any easement, rights -of -way, mining or mineral reservations, of
sight or of record, legally acquired. Together with all water rights mineral
rights, improvements and appurtenances thereon situate or in anywise
appertaining thereunto. Subject, however, to all reservations, restriction,
exceptions easements and rights -of -way of record or in use.
A copy of the contract if available: Contract was verbal.
DATED this W' day of December, 2000.
STATE OF WYOMING
ss
COUNTY OF LINCOLN
Witness my hand and official seal.
My Commission Expires:
SUMMIT PEAK TILE
By: --fi rev,,
JAREMY ERICKSON, OWNER
On this nikday of December, 2000 before me personally appeared JAREMY
ERICKSON, by me first duly sworn, who did say that he is the owner of Summit Peak
Tile and said instrument was signed and sealed on behalf of said Summit Peak Tile as
owner of Summit Peak Tile and JAREMY ERICKSON acknowledged said instrument to
be the free act and deed of said business in acknowledging the foregoing Lien
Statement.
Lein Statement Page 2 of 2
NOTARY PUBLIC
TERI BOWERS NOTARY PUBUC
County Wyoming
My Commission Expires
MAIL CIiFCK TO:
Summit Peak Me
P.O. Box 7823
Jackson Wyo, 83002
(307)890 -9539
Date:11 /18/00
Man Hrs.: Jaremy- 54 hrs.
Laborer- 15 hrs.
INVOICE
SVMM1T PEAK T1LE
Jim Key Residence
548
Materials: Tile Freight Charge- 680.00
10 Sheets /2" Wonder Board- 150.00
2 Cylinders Grout- 25.00
Mesh Tape- 7.00
Screws- 15.00
6 Tubes Caulk- 25.00
Colored Grout Caulk- 12.00
Paper Shims- 20.00
2 Bags Thin Set- 30.00
Acrylic- 15.00
Sealer- 60.00
2 Corner Caddy's- 50.00
Total Cost 3,699.00
i N.
Date Due:11 /27/00
—gym
2,160.00
450.00
Thank you from Summit Peak Tile!!