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Recording requested by <br />and mailed t <br />2222 13cs∎el v 11e 5 i- <br />Gr'ar,d 151 and , Nt <br />(99803 <br />The undersigned claimant, <br />upon the rea property located in <br />- s et. and described as <br />After deducting all just credits and offsets for claimant's work and material, claimant is due the <br />sum of <br />$ t 3j P --- together with interest thereon at the rate of _ % annum from <br />, <br />2 <br />Claimant performed worlf a the request of <br />Name and addre of <br />Owner <br />Notary Acknowledgment <br />State of <br />County of /ict...x --r <br />rrs <br />•n <br />n 7> Zri <br />ft t61 <br />Claim of Mechanic's Lien <br />ss <br />, furnished work of improvement <br />County, State of <br />Is <br />On the/j -day of S b-e. , 2 00 before me S ca'e <br />(here insert name and tifle of the officer), personally appeared o s 49 S -� <br />, personally known to me (or proved to me on the <br />basis of satisfactory evidence) to be the person(s) whose name(s) is /are subscribed to the within <br />instrument and acknowledged to me that he /she /they executed the same in his/her /their authorized <br />capacity(ies), and that by his/her /their signature(s) on the instrument the person(s), or the entity <br />upon behalf of which the person(s) acted, executed the instrument. <br />WITNESS m P. � d and officials • .1. <br />Signature (Seal) <br />6BN6W. MOTMV • Slue at abaft JULIE A BRIaENO <br />My Cam Exp. Sept 30,2016 <br />N <br />CO <br />CD <br />CO <br />