Fill and Sign the On This the Day of 20 the Undersigned Does Form

Notice of Satisfaction of Lien Page 1 of 2 Prepared by, recording requested by and return to: Name: _____________________ Company: ___________________ Address: _____________________ City: _____________________ State: _____ Zip: __________ Phone: ________________ Fax: _________________ ----------------------Above this Line for Official Use Only--------------------- NOTICE OF SATISFACTION OF LIEN--INDIVIDUAL (Wyo. Stat. §29-1-302) On this the _____ day of _______________, 20______, the undersigned does hereby acknowledge receipt of payment from __________________________________ in the amount of $______________ which represents payment in full for labor performed and/or materials furnished by _________________________________ for the following improvements ________________________________________________________________________________________________________________________________________________________________________________________________________________________ to the property located at: _______________________________________________________________________. By this document the undersigned lien claimant hereby releases any lien it may have in connection with the above-described property for labor performed and materials furnished. __________________________________ Signature of Lien Holder__________________________________ Type or Print Name Notice of Satisfaction of Lien Page 2 of 2 STATE OF WYOMING COUNTY OF __________________ This instrument was acknowledged before me on the ______ day of ______________, 20______, by __________________________________ (name(s) of person(s)). ___________________________________ (Seal, if any) (Signature of notarial officer) ___________________________________ Title (and Rank) My Commission Expires:__________________