. � �S <
<br /> , _
<br /> e' ` " ' '_
<br /> .. ,- �,� . � .. . .. _
<br /> : � _ _ � __ . .._.� ..-.. �---w-`.Cfw�ro :n-•. .�"r��_
<br /> { �- � -.a..-�v:� :...- .. .- _ - F -- t � ti r£t-r(� �' ys'�,,. C 'c�.-.,.n�r•, --- _ .. -
<br /> - r.x �_,,,�'�, F p., - � , � .. p, - • � s � _ < . ._4., r �� v.Y °� �� F_ E4 � .,.�4.-r.- ....,.<-'f -�si „y`"�
<br />- - f -. �} - `5 r �`�c. G3 r�- i .�� s n ��� -G ^ � o�.�� �-�{:
<br /> ;2�ros'� .c: ,:'St}. �?2_,c�--.`.ti. ..r �k._ � ��� � _ a,`u�Pc ~t'� - cL�f .��:
<br /> . •`y ,`'�- .L•., „5` t. . , . . . �..-e.i5 . -
<br /> �� - 4`�} . . . a r ' � . . ' . . ' . . � . . , ' �.--
<br /> -� �'Z','r'� . . . . . ' , . . �. . � .:<rh
<br /> , "• . . - ' .�etb[��P,I`JdiCt�Eia.ttso"{I�!'d.`�tL11SSffi�if. -
<br /> E ~ ��=t�:'ai�t1l�PEO•r3i.41V. ` , .- : ,.�n` - . . �" � c.'._
<br /> �
<br /> . �i ' � � ^, � � , . .�G -�-�'-
<br /> � '� � � . . ' , � � � � - . � � ' � t� �:�,:
<br /> � . . . � .. . � . � �
<br /> . . , . �� � � ` -'f"�'
<br /> �G � � �� ', . .� a . < � � � ..:.
<br /> E� . < , �� � .
<br /> .p'� y' �r.�
<br /> . . � . � � . � ����:
<br />. �` t (� , � ' � � `` ":
<br /> � � yl �7 �q �. '�5,��
<br /> .4�• ' . . � � �� � �`��"�..
<br /> . . �s,. D� � � �.
<br /> . � _ . � � � � F `,;Y�`:
<br /> 4 ,-� - _. �`-- — ---_-_ (,`QjVbI.YtU[.:l'ItJiv i'^°.' � f� � - - � �
<br /> ��.
<br /> ,.. �F • . , �K`
<br /> r � . � �+�.
<br /> `:' ��'� ������ ��atu �.;..�... /,��,� rt�Gt/�, � - — �'' ` -
<br /> �s e���� «.,��.v --� w
<br /> �. ���� - . -
<br /> .., . "��oSS- eQS �z �r t �Q�n � ��� 4._
<br /> .,� � f, � � ��_ uit�aL'm tTae teal estate the lien�ia C�laim�i� �`�� (�tr1S'I YUt�'l tJt� G _-
<br /> . ��, ������ . � . S�Lth tn8�o1
<br /> F F, , .: ��.,� � � r �r�nd �' -_--
<br /> . t�e�-he�o� �oar � PO � � �' _-
<br /> ' ,�;o��e� b
<br /> ��� : � 3. 'The name and addYess of td�e c,laina,ant i� . , ._
<br /> ,`- .., . � .fo�� � � ---
<br /> f �::�.��` ��3� r� ndQ A1� . C CO»s e�4n
<br /> ,.r . •. � t oou�ac�bed i� ��' - _-
<br /> ;L� 4. .The name and�add�s of tdse ge�witA wh�n the dau�ian : --
<br /> �:�:��, � ;;.4��;:�� � t� �y.�h � 7�0. S� S i1r a2 �.�` n� N€ t�8d�01� ..
<br /> . . .�s�ervloes P�ed to,to he .P��.°.r��8�ed or to be . �
<br /> 5. A genecal dasc�►P�af the�e oontaact P�� � �_
<br /> ':; fifqcnislaed fa=the impwvement �G��' , ----
<br /> ° -� ����.�tec� ew seet� o�s o�a "l�x? aae�4 e � ----
<br /> � :,. . . . .
<br /> - . � � . . . . � ,
<br />- . :t, . , . .
<br />- .. � � � � . � . . . �, =__
<br /> � ;„ � . s �tc�m�o�o�+���� � . � . � � �,.� �_
<br /> j1,�..�: . . . . . - .�. , �$ 3?5.0�0 . y.;.
<br /> ��;� w�pt�t�due or nat,to t�e cla�t for the servio�or'n�h� - i
<br /> , e:�onnt na�aid,
<br /> . ' , te in the smmmt of$ ----�---� • - ----
<br />_ .` � . The un�aid a�t 3s not Sxed bY the aontaact.�bnt a good.fait3��ma n--- -�
<br /> ` �?. tComliP�onQ of t3�e followinn? . """
<br /> � .. ..- �p-o°�'j p17 , �
<br />°° �, • �,The time the laat servi.oes or materials were farszisheci was �'= ._.-
<br /> The time the Iast serviaes or materials were�fumished I�as not yet oi�em�ced but ie estimated to oavr � _—
<br />._ � •.y: . . . . v.�._.
<br /> -' • . _ - . ��" ..
<br /> - � +� �' . . . ras�rr
<br />— . ..1.'�./.`tih�• . � . . _ . � g._.
<br /> - ' ;�;i�:., , . . � . .• . . . �.R.�.
<br /> .� ..�G� � M� -
<br /> � ; : � � . �Si�nawre o Claimant . _
<br /> o. . . . . . . n�`-'
<br /> :T__ .. � ,.. : . R�":--
<br /> ,
<br /> .. � �i� � n-' �-
<br /> ,, � . , . . d�y of .��d2'� ��19�.. �_'•
<br /> � � , � Sabsribed and swom to Uefore me fi3ris // ^
<br />_ . � . y� 1lOTMY•Sta2�al�teDrosl� CTQ. t � •�/ , '`
<br /> . .. �K�1 � _�
<br />-.- - ` �:;��, : 1�`1 CAtdlltpD tv►�UBY • otaiY Public . :
<br /> ,; � lryamcaE�ltsr.0.2�D7
<br /> - , � . '.., •
<br />-y" . . ..f (52-147.See 52148 fos amendmen�52�149 fox asffignmea�5�13?for recazding t�m�52�1€4 fox discharge or release). ,
<br /> ;,.. . . � .
<br /> - _ • . .. . � . . � .
<br /> - �
<br /> .
<br /> �..:::.: _ -_- . .i . ..
<br /> ' ' ' � Rev.9195
<br /> � � � � . � ..__._._-- '�" "------ • �__�_`.. .�-....._ _,- -,•..._..�,,�....---�_:._.. � , �
<br /> —.-�:.-•-,.-- . . ..... ..,��:::�..�.�-.�. . ��� ' _wJ.:.�..�. �,...,�._�.;r,..:'�...,:..::.�x•�ws.�..:.,.� >,�',�.,,.,...;..,�,.�..:..�=,a'�.,.a.��.� .,+� - -
<br />
|