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<br /> � duly,ttuorn,on lais onfh rayr that Uie forcgoing itrmi:rd acco�ant o(work,fabor,skifl....�C!h�.�/.��...�J,(/T/:`.R(ij
<br /> matertals,and i nprovrinrnft is true and corrcct: tlwt anrne xccrc Jone and(�erfo»r�rd and furnished by tke ur.dzrrigned �
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<br /> � on th jopowing fot piccc os pa�re!or land,zdr:•...�.Q.. ....... ..........L,,J..�s f1..�..C,.. � ....-J"�f....�./.�.5.�.. i'
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<br /> � ! That �!!he lirr.e said rontsnc�rar rr�ade mid laGo�and materia(s t�rnisl:cd unJ dclivrrcd U�eseundrr........................
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<br /> ; ;: Thaf thc dafe of th¢ first ilrrn/urnishcd nnct dciivrrcd :�tis.....................��� ....7�
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<br /> ' Affiant furfher.rtales fhaCtaid fabor u,r�a pe�formed on,and rnatr�ials wrre furnis/ied for, deli;;rred at,ond used in�
<br /> ,j � raid building os hrcn:iac.c on and brfuccn fhc dafct tpcci�ird.
<br /> ; �; T at th� prices c arge�: lhnejor are1a' and rra,ronaGie, and tha! lhe�r is no•u d�te r,n said atcounf (he sum oj
<br /> i ;I .��..�c�........���-J..U..�..!�./.�'..��........����.�Y �:'.�11/.�....�..��.0...................Dollart, that soid°
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<br /> � '! ............................_................._......_... ............................................claims a lirn on !he taid hremites for fhe/ul!ancount of �
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<br /> ;' i raid acrounl, to-udt: Tl�e s�a» of,"p....,..Q..�..Y.i....�.f..r.2.......................togalhrr uatli infrrrsl fiierron af thc legal rate,�
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<br /> < Jrom thc....__.�OT�day of-........�,1��.n(..�.�/t�...._.. ....? ... ., tp. ..7.7and �urlltrr ojfianf ra�v nat.
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<br /> �� : �! Rodney Lw�is St:otf�,.._.{.N ..S..J�.�...���. ... f�'L...... .........
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<br /> � _. OENERAL NOTARY �J _.uti.,....` ,�..�. ...t,....�,Fi.3.. ............r�.:. ...Y.....F.�.....
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<br /> ;- �� �; Cornmhston rxpHi+f�n ed in rny pruence and naorn to be(ose mc fhir....._..`.:'1...............................I
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<br /> � i; ' M&Y i, 197�yy�a( -..............`,..::`:�5.................. ; .�..��.> .-t�'-� .1 I �
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<br /> � • ii (See rererse side for�nstructions) 2tary public.
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<br /> �'1��k��.' , ,! A9 Gnternl on numrrica! indez nnd filed (or tecord� ,' � ,��� '-,
<br /> a�b-� ,� County ...................................__..................................} in the Register o!Decds O(Ticc ut said County tbc�
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