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<br /> . j 221-A—MECHANICS LIEN (Revised Y962) . . .'�- TSe HuHman General SuPV1Y �ou�e. Lineoin. NcDr. ;; . � . . ...
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<br /> � Lirn claimed by: 78� O O 3 O 8(� r9 �'
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<br /> , Claude Clausen i
<br /> ........ .....•--•••----�-•----...__....----._..._.._.------....__...---••-•...._._------ flgair,.sr:_._Century.Builders/.---•-• '`I
<br /> ' Centra2 Ci ty, Ate, Arnie Thurloir ���� ��������� If ,:
<br /> � Rddress �--•._............................._..._.._..._....._...._..._._._..--•------ --••---.._._..-----...__........._......_..... _.._..._.... ' ,
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<br /> ! 1 13to Labor- Brickxork and Fireplaoe r � � 111 ,00 f:
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<br /> i �� Merrick ''''• �; `
<br /> '; .... ---•----_..............--•--._.._.. Couxty} ' '.
<br /> % j) �q�;ane�� Claude Clausen -•.......................
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<br /> � �j duly swo�n, on his oalh says that the fnregoing iteeni�ed acrount of cuo�k, labor,skzll..._ %
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<br /> ,i materials,and improvernents is erue and correct: that same zeere done and erforsned axd furnished by the undersigxed
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<br /> = fi Jo. ehe said.........--•----•---••................Century_--Builders/ Arnis. Thurlo9r--.--as..contractors_.__...__.. ;�
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<br /> `� � under a' O�1 conHact
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<br /> fo.rh�.--•••--...••--•-erection ...............of a house �i ; .;:
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<br /> �? ox tke follouring lot,piece or pascel nf 1a„d, v��:•.......__...Lot.__Dn�..._.C�4R�.�S?.�..�3.e..a.8ht.&---��.ff�th----•.•-•--•-.-- �! , a ,
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<br /> � That at the!i»te said conhact-c�as �nade and la6or and »zate:�ials /urnished and �cliv¢red thereurtder____________________ '
<br /> �� .._l�r.r�r.�.'...�.la�,:��e_...a.�tA._.Ct..�'.<_�.I...�..-...G..1.A.�.�ee............ . .. ..�,a.r c ourn of s id ¢snsses° +;
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<br /> i j� That the date of the fisst item furnuhed nnd delivered ze�as......................`r�ug�„1�� 1978 a� the � .
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<br /> � 3}� date of ehe Jast item was..:._...•-•••----January--22,�---1 I�8_....._----------------------•------.---... �;
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<br /> 3� Affiant furthes states that said labo�¢uat performed on, and matcrials zc�ere furnuhed fos, de/ivered at, and used in
<br /> .3 �l said bKilding or p�emues on and betzneen the dates specifred. �f
<br /> 1 �i That the prices charged thesefor are fais and seasoriable, and tluit tkere is now due on said account the su+n of I� �
<br /> ; �j _One thousand one hundred ten and no/300----------- Do11a.s, thae said^ {'�
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<br /> � --•--•------...__•--_.._-•-••••--•••--••--•-•••-•-----....•---•-----------..__......_.claims a lien on the said prsmises for tht full amoun! of
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<br /> 1110.00 ;'
<br /> said accou„t to-avit: The sum ot g....................•-•-••------...-.---_----..._.
<br /> � � �2 J8Y3118►Ty �� ' ' • • -together witj��}nte�est thereon at the lega! rate,
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<br /> '{. ,.. S+ebscribed in my esence and sworn to befo�e me thu.•-•-•----18 ..__.-----•-_-- �;
<br /> . day of .............-••-------•---...------•�---------...-------.:-�-,.._..__._.--•�-•---- --• 19- �- - --- ;
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<br /> d_(See reverse side for instrucdons) tas Public. �f cr `
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<br /> ` 3TATF OF_,.:_. ._.:._._... __......_.. Entered on numericai ind an Sled for record 1
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<br /> ;. ' .,Co,ualy ..........,.....».... ....:__.._ _..:_......__.........} �a the Register of Deeda Offece of said CountY the �; � `;,' . .'..
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<br /> .e...`.......d+ly.oi.r...... � � 19 ._...., at:.----......._.._..._._...--o'clock and-----.................'...._minutes ......----.........._.M., �f -
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<br /> � and zeoo:ded,in Book:......_....._...._ _.._..••-'•• of__....................._-----......st PeBe--.........----....-•----......._----.... j� ri+ T,�
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