HomeMy WebLinkAbout885914 RECEIVED
LINCOI....¢I 60Li',ITY CLERK
WYOMING.~[!E~ STAT '~EMENT
THE UNDERSIGNED LIEN CLAIMANT, pursuant to Title 29, Chapters 1 and 2
of the Wyoming Statutes, is filing this Lien Statement at the Office of the County Clerk
for the County Lincoln, State of Wyoming, as a claim and lien on property and for the
matters described and referred to herein as follows:
(1) The Undersigned, Clearv Building Corp., whose address is 190 Paoli St.
Verona, WI 53593, is the Lien Claimant and person seeking to enforce'this Lien.
(2) The amount of the claim for this Lien, which isdue and owing to the Lien
Claimant is $_8301.37.
(3) The name(s) and address(es) of the person(s) against whose Property this lien
is filed is .Ralph Boedecker, P.O. Box 821, Thayne, WY 83127.
(4) The following itemized list describes the materials, work, labor or services
delivered to or performed at the premises: .Provided labor and .materials for construction
of a .40'x66'x 13' Post-Frame building. -
[attach and refer to itemized list as "Exhibit. "if necessary]
(5) The person(s) against whom this lien claim is made is: Ralph Boedecker,
whose last known address(es) is/areP.O. Box 821, Thayne, WY 83127.
(6) The materials, work, labor or services, as referred to in Paragraph "4"
hereinabove were/was last performed on the 10th. day of October, 2002.
Or, if applicable, Alternate Provision:
(6) The project was substantially completed on the day of_
(7) The legal description of the premises where the materials, work, labor or
services were delivered to'or performed at is Haystack No. 1, Lot 1, T34N, R118W,
Section 17.
(8) [This Paragraph is applicable only if Contract is available] A copy of the
applicable contract for this claim of lien is attached hereto as "ExhibitA".
Dated this .1. 9th day of November, 2002.
Cleary Building Corp.
Signature of Claimant
STATE OF WISCONSIN )
) SS.
COUNTY OF DANE )
Verification
Steven J. O'Brien, of lawful age and upon being duly sworn upon his oath, states and
verifies as follows: he has read the foregoing Lien Statement and understands the
contents thereof; that the mattm:s contained and referred to therein are tree and correct to
the best of his knowledge, information, and belief. Signed and sworn to me on this 19th
day of Novembe_r, 2002_. - _
WITNESS MY HAND AND OFFICIAL SEAL.
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Mv ~6mmission expires: / 7.-
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