Fill and Sign the Wyoming Filing Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ___________________ Company: ____________________ Address: ____________________ City: __________________ State: _____ Zip: __________ Phone: _________________ Fax: ________________ AGREEMENT TO EXTEND TIME FOR FILING LIEN –INDIVIDUAL (Wyo. Stat. §29-2-106(c)) COMES NOW, the following parties to a contract for which a lien may be filed: _________________________________ (name of owner) _________________________________ (name of contractor) _________________________________ (other party’s name and capacity) _________________________________ (other party’s name and capacity) to enter into this Agreement and would state as follows: 1. The above parties agree to extend the time limits within which a lien may be filed as provided below, the times not to exceed twice the times within which the lien would have to be filed in accordance with Wyo. Stat. §29-2-106(a). 2. Every contractor shall file his lien statement within ___________ days (not more than 240 days) after the last day when work was performed or materials furnished under contract, or from the date the work was substantially completed or substantial completion of the contract to furnish materials, whichever is earlier. 3. Every other person shall file within ___________ days (not to exceed 180 days) after the last day when work was performed or materials furnished under contract; from the date the work was substantially completed or substantial completion of the contract to furnish materials, whichever is earlier; or with respect to an employee or subcontractor, after the last day he or she performed work at the direction of his or her employer or contractor. This the _____ day of ______________ , 20 ______ . Agreement to Extend Time for Filing Lien Page 1 of 3 ______________________________ Signature of Owner _____ _________________________ Type or Print Name ______________________________ Signature of Contractor _____ _________________________ Type or Print Name ______________________________ Signature of Other Party to Contract _____ _________________________ Type or Print Name ______________________________ Signature of Other Party to Contract _____ _________________________ Type or Print Name 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: __________________ Certificate of Delivery I, __________________________________ , hereby certify that I have delivered this day a true and correct copy of the foregoing to __________________________________ by: Agreement to Extend Time for Filing Lien Page 2 of 3 ( ) Mailing a true and correct copy of same by certified U.S. mail, postage prepaid, return receipt requested to __________________________________ . So certified this the _____ day of ______________ , 20 ______ . ________________________ Signature WY § 29-2-106 Agreement to Extend Time for Filing Lien Page 3 of 3