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I <br />INSTRUCTIONS: <br />(t) If the lit" is claimed by a fir#x or corporation, state here #hot apaut is a tnelrtber of the /irut or his <br />offldal capacity in the corporation. <br />( ?) State her/ whether verbal or written contrae#. !f awilltN, attach copy, as lien is Maid. <br />(d) "Erection," "Construction" "Alteration;' or "Repair," at the case 1110Y be. <br />(�) Here irw:ert correct ltgal description of land. <br />(s) 1f the id&or and rhattrial twre furnished the contractor and not file otvner direct, state "that ............... -- <br />it-as the contractor on said building and acting for the owner." <br />(6) 11 mote has been gi e". say "said amount is further evidenced by a proutissory Mote, a copy* of suict Mute <br />being hereto attached and marked 'Eshibit Y." <br />ALAN C. SMITH AID WAIWA•ti. SMITS, NUSUM AM Vlra <br />1 <br />ar jnot tnAsu •etA right of roart•."tip. rawJ so as eMAM is fewoK 60 tewob / 4 MM WA rod few M <br />MALL (%"q. nuRASRA <br />A PART Qr TMt NORTMUST QVMMM O! 1MS S0Ln *'nT QVAV" Or StC I M 26. TOWtSMIr 11 <br />i NARTV..'VkAMG9 10 VEST Or Tbt 6th ►.M., MALL CMMtT, MSIRASRA, DESCRttto AS TOLIAWS1 <br />I orclswisG AT Trir nO ror-im CAQ.vTw Of Mt SOLMMKST QUARTER (3144) or srCTION $4, <br />TrJs"I► 11 fiRIttV. rAsa? 10 t:rcT rt'!i' jpo Inoue soura on TRIJ MQTrJILT LIPt Or SAID <br />QtpjyZ% A D15TAytk Or 1tt / :Et TO THE r01111 Or 8L3IX4VK;, frt:}F!tt 3MQ O�SAID QV AR-' <br />!Qt'3umm or 90 ►EET. TMENw! aUwl4C WEST ►AMUL TO IM �. <br />sfcn"V A D1s -ruct or lfi3 nET1 TMOKS am. Ila out WIIM rARALI.t'L To 713 rMT LtRt <br />:or $Art) QUARMI StCTIMt 1 D1STAM OF SO FM- AMIMU' MtMC On ZAST'rARAUSL TO <br />' O SSLZIOM A 01STAM (w 1f3.Er -in M pun of SGIlatnt, <br />.1/M i 1T , <br />1 V <br />✓C� <br />i <br />1 <br />! 7 � � ►�� � � i{lif �OJ <br />t -1, .. . J'. � i..i�s�A <br />�sa:�aatr;� <br />MUM) <br />L00CA1 -68 <br />ON 41/0(ltrQ0(j SO f?i.1:6:03 <br />L <br />F � <br />N: <br />.�1 <br />a ° <br />J <br />■ <br />t '- <br />r- <br />- -t <br />F` . <br />I, <br />lJ®r <br />G <br />.La <br />hr <br />G <br />W <br />O c <br />C a tJJ <br />r�1 r0 fj = <br />Y <br />u <br />opt <br />�,: <br />C <br />a <br />A�. <br />K `_� <br />G <br />Co C� <br />Ci7 <br />✓C� <br />i <br />1 <br />! 7 � � ►�� � � i{lif �OJ <br />t -1, .. . J'. � i..i�s�A <br />�sa:�aatr;� <br />MUM) <br />L00CA1 -68 <br />ON 41/0(ltrQ0(j SO f?i.1:6:03 <br />L <br />F � <br />N: <br />.�1 <br />a ° <br />J <br />■ <br />t '- <br />r- <br />- -t <br />F` . <br />I, <br />lJ®r <br />G <br />.La <br />✓C� <br />i <br />1 <br />! 7 � � ►�� � � i{lif �OJ <br />t -1, .. . J'. � i..i�s�A <br />�sa:�aatr;� <br />MUM) <br />L00CA1 -68 <br />ON 41/0(ltrQ0(j SO f?i.1:6:03 <br />L <br />F � <br />N: <br />.�1 <br />a ° <br />J <br />■ <br />t '- <br />r- <br />- -t <br />F` . <br />I, <br />lJ®r <br />