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When Recorded Return to:
Espy Law Office, P.C.
I-lansen Building
2515 Warren Avenue, Suite 501
Cheyenne, WY 82001
9 013 V,.. I. ,...:
RELb_'ASE OF VERIFIED LIEN STATEMENT-
Claimant, State of Wyoming, Department of Health, Office of Medicaid ocated at
2300 Capitol Avenue, Rt.:om 147, Cheyenne, Wyoming 82002, hereby releases the
VERIFIED LIEN STATEI~tENT FOR LIEN FOR MEDICAL ASSISTANCE which was
recorded on August 25, 2003, in Book 532PR, Page 40, as Document No. 892747 on
property owned by Kathleon Erickson and affecting the lands described as:
Part of Section 33, T35N R119W of the 6th P.M., Lincoln County, Wyoming
being more particulirly described as follows:
Beginning at a point 174 1/2 feet East from a point which is 3 rods East and 2
rods South from the Northwest corner of Lot 1 of said Section 33 (which
corner is known as 'he center intersection of the streets running North and
South, East and West) and running thence East 140 feet;
thence South 8 rods;
thence West 140 f6et;
thence North 8 rods to the point of beginning.
Together with all improvements situate thereon and all easements and
appurtenances belonging thereto.
2004.
The above described lien is fully released as to the above-described real property.
IN WITNESS WHEREOF, do hereunder set my hand this ay of June,
STATE OF WYOMING . )
:) SS.
COUNTY OF LARAMIE ')
State of Wyoming ', ~
~ ... Department of He-~l'th
Its: Recovery Manager
The foregoing Relei;]se of Verified Lien Statement was subscribed and sworn to
before me by Debbie Paiz this //~'-¢'J./.& day of June, 2004.
My Commission expires:
WITNESS my hand and official seal.