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CONTRACTING OWNER OR SUCCESSOR IN <br />INTEREST: <br />CLAIMANT: <br />deed. <br />3 <br />(1 <br />de„, <br />41_4 <br />(Name) 31p 2 <br />(Address) Af <br />ter0-3 <br />jert- ..i4F•. e-- <br />(Phone) <br />1 8 County <br />ss. <br />On this _12_9e/1_ day of Jldkae <br />r <br />My commission expires the D day of <br />STATE OF _gg,N2r0A1/104_ <br />Vtca <br />County of <br />day of .--------- <br />and recorded in Book of <br />}ss <br />at page <br />CONSTRUCTION LIEN <br />REAL ESTATE: <br />, <br />C/) <br />U) <br />;..N <br />1 1 ;A) <br />o.$ -i <br />) — <br />-1- <br />- <br />rn <br />r- <br />-n cz) <br />rl <br />rn <br />C) <br />(Legal Description) / <br />74°71`61 AP' 22 , /--5 1 4j <br />CLAIMANT CONTRACTED WITH: <br />Q) <br />2: <br />x rn <br />> <br />C') <br />SERVICES OR MATERIALS FURNISHED BY CLAIMANT: <br />4 41,- <br />(Mune) / • <br />/174 fr "ti! <br />(Address) iiaj <br />**# AP F,A5 <br />r lj d <br />(Phone) <br />CONTRACT PRICE: $ AMOUNT UNPAID: $ <br />TIME LAST SERVICES OR MA RIMS FURNISHED .» <br />State of <br />, before me a Notary Public in and for <br />said county, personally came ..__.1..__GC).12kOpo to me known to be the identical person or <br />persons who executed the foregoing instrument, and acknowledged the same to be his, her, or their voluntary act and <br />Entered on numerical index and filed for record <br />in the Register of Deeds Office of said County the <br />o'clock and minutes M <br />Reg. of Deeds <br />By_ _Deputy <br />or-) <br />1 `1,„ <br />