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<br /> ; duly.rtaorn,on his oa(!i sa�r tlmt the foregoing itemiced accaunt o/work,la6ar,sl.•i/1......ld'Ro.r....................._-...----•- !.
<br /> ° � i niaterials,and in:piovev�cnts is trui�and ronect: tlwt sane ucrc done nnd per(armrd m�d furnishrd Lp the undersigned , �
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<br /> ' �I I on the foDouting iot,�icrr or pnrcc!af land,en�:'........-.--..........................................��---...-----.....---...._........_............_....._... �
<br /> � i ..-•---------------•--•�---...-Lat�.3...itaxar�zsr....N�ll�...��sbciyision............--��---... ............................................_--� -
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<br /> � That at!ha tinre said cunfract eras�>�ade amd labor ar.d »mtrrr<ils f urgishcd oad dcli�r�ed thcrc�mJer...............
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<br /> i rt�ar ����dare of a���first sfcrn ju�nuhcd nnd dehvcrrd .ras...Septe,mL�r..2$.,...1�7..fl...................._...__..... and the I
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<br /> ! d(jwnt further statrr thaf said tabor.tbs�rr/ormed an,and nmtcrials.c�rre furnished (or, ddivered af,and tued ia ! ;
<br /> ' ( said builJing os prcmises on and bctxucen !hc dates spetificd. 4 ;
<br /> That 11te ¢rices chasged theeefor ase fair and teasonable,and tGat there is n�w due on said account tF.e sum of I :
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<br /> ...........................................•--•-....................._............-•---.................clairns a licn or. the said Frentises for fltc(ul1 amount of � .
<br /> � ; � raid account� t0-TL7O: TJi¢ S1tHt oJ$...........................................................tugefhzr 2vitli interesf tl:creon at !he legal rate, � j
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<br /> � , I SEAL Substribed in my Qresence and strorn to be(ore me thu.........,14................_--_--•---..... i ;
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<br /> � , i dcy of.....??�.�ember......._...................._........_............----....... tg.._76....
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<br /> �, �I i STATE OP............._.............._......_............-•---..._......... F.ntered on numericn mdez nnd filed or record � : � �
<br /> ' � � pounty ...................._..}Fe. in the Register o[Dceds O(ticc o[said County the � � ,
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