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E&S
Hansen Building
2515 Warren Avenue, Suite 501
Cheyenne, WY 82001
'-'EOFIVED
COUNTY CLERK
RELEASE OF VERIFIED LIEN STATEMEN'Ii,
Claimant, State of Wyoming, Department of Health, Office of Medicaid located at 6101
Yellowstone Road, Suite 210, Cheyenne, Wyoming 82002, hereby releases the VERIFIED LIEN
STATEMENT FOR LIEN FOR MEDICAL ASSISTANCE which was recorded on April 11,2003, in
Book 517, Page 443, as Document No. 889127 on property owned by Florence Sudonik and
affecting the lands described as:
The East 3/4 of Parcel 37 of the Town of Diamondville, Lincoln County, Wyoming as
described on the official plat thereof. Together with all improvements thereon, and
easements, appurtenances and incidents belonging and appertaining thereto
Aisc the West 1/2 of Lot 10 of Block 21 of the Town of Diamondville, Lincoln County,
Wyoming as described on the official plat thereof.
Together with all improvements thereon, and easements, appurtenances, and
incidents, belonging and appertaining 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
Florence Sudonik has an interest.
IN wITNEss WHEREOF, I do hereunder set my hand this ~ day of September, 2004.
STATE OF WYOMING
COUNTY OF LARAMIE
State..~f Wyoming,
D~C'~rtm~ nt of H e alt h~.~_~.~.
Its: Recovery Manag
The foregoing Release of Verified Lien Statement was subscribed and sworn to before me
by Debbie Paiz this ~..'~ day of September, 2004.
~c,,0-,~ WI.T.~IESS my hand ~pd official seal. .
cOUNTY OF . '-.
~~ Notaw Public
My Commission expires:.