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<br /> �
<br /> � JNSTRUCTIONS:
<br /> (r) „If'!he liess 'u claimed by a fjrm o� corporation, state here that a�fant u a member of the fism o� his
<br /> ' ;" o�'itial capacity 'raa tke corporation. ' ,
<br /> i � {t)'_State hcse uihethir vesbal 'or`uwritten contract, i7f writlen, 'attach copy, or lien is void.
<br /> � cy�3),`"Erection;, •:Coqrstruct£on,,, •'fllteration,' , or "Repair,,, as the case may be_ : ; , '
<br /> ' � }� (4) Hcri snsert correct,legal description of la�d. l ' ��;
<br /> � �,(5) If the ta7ios' and mdtesiaF were furnished the contractor and ssot the oumer direct, state "that.................. t �
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<br /> ,, x � �^ was the , co�tracto.r on sasd buildi�g and: acting fw the, ounser"." ' ; , R;
<br /> ; (6j ;ylf �oi'e hqs bac�t 'given, say "said- a+xount is further evidenied by rs promissory note, a copy of said nate t�:
<br /> .' j . 'besnq �Cereto 'attached and marked `Eshsbit B:" s '
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