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<br /> �ii 221-A—MECHANIC'S LIEN (Revlsed 1962) _ She S1uRmnn General oupply Houee,Wocolu,Neba i' '
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<br /> � ' duly r�orn, on Izis oath scys that the foregoing itemi�ed account of work,labar,skill.............'r1.[�,t1x1�................. ...._ f
<br /> � ; ` materials,and i�nhroventcnts u truc nnd carrct: tlwt smne xucrc Joae aid per/orrncr!and furnuhed by the ttnderstgned � : �
<br /> � I �or the said....'er9onel,ized...Home,�...Inc:...�'d�..Ard..Jenk.ins......--�---....._.............................................. ........ I ' `
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<br /> ; : Ken'rl�h Ailbez Gubcivi�lon ......... ..........................
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<br /> : That at the time said conhact,ras»mde m�J labor and matcrruls fusnished mid delivcred thercundzr.............. �
<br /> ' � ....�Praonallzed Home Inc. F:S�� .................... ......�---�-- ---- i
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<br /> Tl:at the date oJ Oie�irst ite�n �urnisMed nnd dclivcred aras........J?I.DP...2z.._7.�.�E?............................_........ and !he � !
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<br /> Ajjwnt further states fhat said labor xuas perJorrned an, and �natcrials u�cre �urnished for,dclivered at,and ured in �
<br /> j � raid bt�ilding as pretnises on and bet:ueen the dates sQecifrrd.
<br /> ' That the hrices charged fherefar are fair and rearonable, and t/iat there is nozu due an said acco:�nt the sum aJ �
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<br /> > said_¢ee0u , 't: T1�e sum of$.......__.........--_.................. ..............._fogethcr witl: intcrest flicreon at tl�e lega! rafe ;
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<br /> ; �, , �$$�L Subscribed in my ptesence and swosn to be(ose me this.....��'•?------_--_............ ........ i '
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<br /> � ; h��� Commiasior. ex�ires Feb. 1F,19i7 r -,
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<br /> :; � (See reverse side for instruc6ons) ' � ' -'
<br /> A otary Publia � � a� ,.
<br /> ; ��� , STATE OF............................................... ................_ �ntemd on nur�erical index nnd filed for recorci ' ° ' a �
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<br /> L j i County ...................}�� in lhc Register of Deeds OlIice ot sxid County the i [ � � '
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<br /> ' � � nnd recordal in Hook......................_..............---ot.................... .......at paRc.................. �
<br /> ,:.., . ........................................................Re�. of Deeds j
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