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.. . .. �,. <br /> ..,... �....,,,, . . .� � . ._ ..._....._-- - -—_—-- — _ . <br /> �.. . ._.._.-- -- - _ _ ._.._ - <br /> - -- -- - - <br /> -- . ._. �-- ---------- __-—_—_---- <br /> r.�'f:�..:'f.EC;�.;s:ra;�-_..._._ . ....— -.. � � -- ---_..- . _ <br /> ._. .._ _ ._ _ . -- . _- .__. . __ _ __. .._ .I._ ��--.. <br /> I� � - <br />� �[ 79� �• id i�w�r�: _ ��00�1 N01�1 PfIM�f1Q CrO.��f10.�{I�IDfI��{6� .. <br /> �1. I --- _ <br />; < <„ �, <br /> n . , <br /> . � <br /> � � b i i � � CO C� h �, <br /> rtt cn ti, <br /> � � :n: � � X -�,/ �Q n <br /> �, p� `� .� ,,, ! �. <br /> � � ��� Y .,� a � <br /> i.? N. � .� M <br /> .� -rt <br /> � � � � � `' � -� � " � <br /> -� � . ;� -� � � �s <br /> ,, t ,. � ;,, � 3 r-� vs�i 9f <br /> � � � � <br /> tn \ <br /> C N O FI� Q ...,..A...' � <br /> � �a �'' ,�� 2�� �.� <br /> 1. 1'1ie reeJ deta eubjeet to thiFS lien is: �.�.�L° _ �►. <br /> a_._I/L����� �/o �,l�' L � '� <br /> . <br /> 2. The�xt e�eiicuat wk�ee interost in the reti9 eatate the lie ie clsimed is: r ��n�r...�t`'! <br /> i�.�s� , S .�„�� 1-�;-�t�..�.►�q�. �a <br /> 3. nnme und addreea of the claiaeant 9ar�� � �-�j --- <br /> r�..,"t2.p�,. - <br /> 4. The name and�ddrese of the p�reon:with,whom t'he claimant oo trncted ia: � � --- <br /> % <br /> 6. A general deecripti of t a a�vicee a o 'e �or be� <br /> fumiohed for the imp vement arec3 the c�,ntract price is: <br /> _n Q ._}.-- : <br /> eA l •_ �s_ �A..�n��? , <br /> , � �-�---�--�,--�"�.°-�r�.,� <br /> 6. (Comple�Ge one of the following) 1T��_ <br /> �The amotuit unpaid whether due or n�to the clsim�nt for the eavioes or materials ie= ' <br /> The unpaid amount i,e not fix�ed by t�1e aontrad,but a goud feuth edimate in the emaunt of i -- . . <br /> 7. (Complete one of the following) <br /> Ttie time the laet eavioee or materivlH were fumiahed wae - - - <br /> The time the la,at eervicee or rartkeriel8 were fumiehed hae not yet oa.�rred but ia ee8mated to oacur <br /> , � � ����C . . <br /> $ignature of Claimant <br /> Suberii�ed and sworn to before me thie �?� _daY f �`�""�'' ,19�� . <br /> �������� Notary Public <br /> ��MIt1�7111 <br /> (62-147.See 62�148 for emendmen�5�•144 for aASignment;62�13?for reoording tim�5�1b4 for disd►arge or releaee). <br /> - , <br /> — --� <br /> �� � _ _ _ <br /> Rs,,.8195 I <br />