Fill and Sign the Wyoming Claim 497432197 Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ___________________ Company: ____________________ Address: ______________________ City: ________________________ State: _____ Zip: _________ Phone: _____________________ Fax: _____________________ ASSIGNMENT OF LIEN- CORPORATION Beginning on or about the _____ of _______________ , 20 _____ , __________________________________ , the undersigned, as a representative of _________________________________ a _________________________________ corporate lienor, furnished or supplied labor, materials, or laborers to ___________________________________ for the purpose of improvements of real property at _________________________________________________________________ , such that the undersigned lienor is entitled to a lien for the value of labor, materials, or laborers supplied. Notice is hereby given that the above-mentioned lienor does hereby assign its claim and lien to ___________________________________ , who shall hereafter have all the rights and remedies under law to which the lienor is entitled subject to all defenses thereto that might be made if such assignment had not been made, for the purpose of filing and for the enforcement of the above-mentioned lien. This the _____ day of _______________ , 20 ______ . __________________________________ Signature _____ _____________________________ Type or Print Name _____ _____________________________ Title _____ _____________________________ Corporation Attest: Assignment of Lien Page 1 of 2 Secretary STATE OF WYOMING COUNTY OF __________________ This instrument was acknowledged before me on ______ day of ______________ , 20 ______ , by __________________________________ (name(s) of person(s)) as __________________________________ (type of authority, e.g., officer, trustee, etc.) of __________________________________ (name of party on behalf of whom instrument was executed). ___________________________________ (Seal, if any) (Signature of notarial officer) ___________________________________ Title (and Rank) My Commission Expires: __________________ Assignment of Lien Page 2 of 2