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�0�209493 <br />Claim of t�ien <br />.....................................................................................................................................................:...... <br />State of / /'�.���S�fi�i � <br />Counry of �i�lG G <br />Before me, the undersigned Notary Public, personaliy appeared ✓�����/9�� ���� G <br />wha duly swom says that he is (the lienor herein) (the agent of the lienor herein) whose ad� is L��' i4Gli <br />�v.� _�,SL.�N <br />and that in accordance with a convact with �9� t�9 �J'��'S <br />lienor fumished labo , services or materiais cons'�sting of: (Desaibe speaally fabricated materials <br />seoarately) O.:�i�L'¢'f'r' /��Gl�9r-/o.���' A �E�r/�'�9G <br />�, ./.�i,%9L�� i9�� �i.P �miv�irio.��:P /st/I�LG�ai.rl� /7'7�9i <br />on the follawing <br />State of _� <br />real properry in i <br />'i�i9.Si�i� <br />reaf property suffidently for <br />r. <br />_ County, <br />aaT�' S'7. S'' <br />G� 4��� . ir.. iy c�. -_—�`� �i vv� � Iri YYIICY <br />by � af a <br />total value of� E r��9�1� /•dE l/�t9b�PE' /�Ei� Dofiars ($ .S%'99�— ) <br />of which there remains unpaid O�%�+iD � Ci� �� �$ / oo � <br />and fumished the first of the ' ms on /� � , 20�_ and the I�t of the <br />items on / �-- � 2Q/� ..�tic�(��e;ti�n i� daimed by one <br />not in privity with the o er) that the lienor served ttis rrofice to owner or1 •��' ��� z , <br />20 by , 3,> , � - <br />(Method o# service) <br />And, ('rf require� that the lienor served copies of the notice on the contract on , <br />20 , by , and on the subcontractor <br />(Metf� of service) <br />on ZO , by . and (if known) on the <br />lender , on , by <br />(Method of Service) <br />Page 1 <br />street and number. /O/ <br />313� / <br />� <br />rrwwsaaates.com - m 2�4. Sovates Mcda. LLC <br />tF136 � Rev.Ow04 <br />