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<br /> °''�''1 � i; CONSTRUCI`ION L.IIk;N �i
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<br /> ::.1 ;.;�.� '' 1. The re�il estaU:subject tn t.hio lien ie: ���u � �M.tl�_�(� ��o� �_ �� .
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<br />:Y�-���'_�:i• ; � 2. The person agairnc�t wtv�se in�terest in th�a real estate the lien ie cluimed is:
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<br /> �-��1' 3. The n�me�ncr:�'addree�s of 2ho clai��r��t iH: �
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<br /> .e�;Jf' � 4. The nAme and address of the Frenaan with whom the claimant oontnacted is: P
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<br /> ; 5. A general desrription of the claimant's services performed to,to be performed or rx�.ateriale furniehed or to be
<br /> ��� furnished for the improvement and the oontract price is:
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<br /> 6. (Co�pleLe ene of tl�o fvUowing)
<br /> -�"" �ThQ arr�a�unt uiipr�id,whother due or not,W tho cic�imant for the servioes or mater�ulg ie$ �• DV ,
<br /> Tha ungaid amoui�t is not S:�ed by the contrrict,but a qaod faith estimate in the amount of$ .
<br /> _ 7. (CompleUe ore of the folluwin�)
<br /> ----� .�The CimE th�e last san�ces or materisils were fi�.mished wag �� .
<br />��� The time the le$t serviaes or materials were furniehed hae noL yet �nocurreci but is estunated to oocur
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<br /> Signat+n�e�Gf Claiman�-
<br /> Subsribed and swom to before me this �1 � day of._�D I�i� , 19 L.
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<br /> Notuay Public �����M��
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<br /> (62-147.See 5?r148 for amendment;62•149 for assignment;02-137 for reoorabng .),
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