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RECEIVED
~- - 3 5 9 LIEN STATEMENT LINCOLN COUNTY CLERK
· ?, yPR F^aE
aen~ns Building gupply, dba aen~ns Aec Home Center,
statement for material prowded to Bffi Pete~on, dba Mountmn
Homes, P.O. Box 454, Thayne, ~ 83127.
1. Name and address of persons seeing to enforce lien: Je~ins Building Supply,
dba Je~s Ace Home Center, 114 H~ 89, Box 3001, Alp~e, Wyom~g 83128.
2. Amount claimed to be due and owing: $11,373.22 plus interest at 1.5% per mOnth
from March 17th, 2003 plus attorney fees incurred in the collection thereof.
3. Nami~and address of th~ person'against whose property the hen is filed: Bill
Peterson, P.O. Box 454, Thayne, WY 83127.
4. An itemized list setting forth and describing materials delivered or work
performed: Building materials including but not limited to, wood, paint, hardware,
fixtures and tools.
JOB ACCOUNT
13651.001 $11,373.22
Plus Interest + 824.81
BALANCE DUE:
$12,198.03
4. Name of persons against whom Lien claim is being made: Bill Peterson, P.O. Box
454, Thayne, WY 83127.
6. Date when labor was last performed or when services were last rendered, or the
date when the Project was substantially completed: July 15, 2003
Legal description of the premises where the materials were furnished or upon
which the work was performed: Lot 72, Plat 13, 1239 Vista Drive, Star Valley
Ranch, Thayne, Wy 83127
David Jenk~, Owner
STATE OF wyOMING )
) SS
COUNTY OF LINCOLN )
THE FOREGOING LEIN STATEMENT WAS ACKNOWLEDGED BEFORE ME BY
RI
CHARD JENKINS THIS //)-DAY OF