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<br /> � ! t>iuterials,and itnprovevtents%s true and conect: that same seere done and crforrsed and furnished Gy fhe undersigned
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<br /> Afjwnt�urther statcs Nmf said labor xuns perfonned on,and mntcsials xvese furnithed for, dclivered at,and used in �
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<br />� I � said building or premiscs on and between the dates sCeci(�cd. '
<br /> ' � Thaf the prices charged fhere(or are fair and reasonable, and that thcre is nozu due on said accounf the sum of i !
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<br /> ; �` ' $�R� ` Su6srribed in my qresence and su�arn to be�ore use this.._..�.:G.'ri..._..........................
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<br /> „ ..'�'ebr�aary 7.8,19'�7 �.�(.cL L(�, ,
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<br /> i (See reverse side for instructions) A'otary Psablic ' . ,;�) # s
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<br /> � STATE OP....._.................................----.._....................1 Entemd on m�merical index und filed tor record i ' � F
<br /> ' t�' in the RcK�ster o[Decdy Otlice o(said County thc I �'
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