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_ m, <br /> , . , <br /> � � .. � �. . ��� ,. <br /> �� ,� <br /> t�n = y <br /> � . <br /> � C <br /> A � � = ct� � � <br /> s p � cc� a, <br /> R � � � `..�.� y 'rn'� C�� <br /> rn <br /> c� '� o �� <br /> ti+ <br /> o c.J .� � CD � <br /> z c�. <br /> t � rn � -p n � ~ � <br /> � �,` C�7 � �"' �! � .N,-. <br /> rs' P" n � c..�n <br /> � W v a O :.� <br /> Cp � <br /> 10-3 Forms. � � � <br /> Z <br /> 'o-3ca� 99 10$205 � � <br /> � CONSTRITCTION�iFtv <br /> � , � <br /> 1. Th eal sta e,s bject ►U this lien is: y� <br /> ' � �J <br /> 2. Z'he g,ers+n �gain�whase interest in the real estate the lien is claimed is: _ <br /> +t.b. .� 1�Q� .._ <br /> 3. The nam and ddr s o tF�e clai�ant is: �►- <br /> . C <br /> 4• 1' nan and address ��'t�+p npr.��n 'th H, tFye claim contr ct i�• _ <br /> - �-�i�e�.� • S�–� <br /> 5. A general description of the claimant's services performed or to be perfo ie or ma ri is fur- <br /> nished or to b f �nished for the ' nprove,men,�g �the contra price is: <br /> r r f � . <br /> , . <br /> : , <br /> . <br /> ��� � <br /> he tota(cont act price is �3,$4'Z;,,. <br /> 6• (Complete one of the following) <br /> $ �5� 4Slt u� aid�hfther ue or not, to the claimant for the services or inaterials is: <br /> �f� <br /> The unpaid amount is not tixed by the contract, but a good faith estimate in the amount . <br /> of: $_�� <br /> 7• (Complete one of the following) � <br /> The time t e last services or rnaterials were furnished was <br /> 4-?s2.- �9 - `�� <br /> The time the last services or materials were furnished has not yet occurred but is esti►nated • <br /> to occur <br /> Clairn . <br /> C,� its: _ — <br /> 7'� <br /> �`' Subscribed and sworn to before me this��_day of__ , �9_� <br /> �_�iAi.�of Ni6t�sk� -- --.- <br /> � OEBOFiAH J.NOR�AAN <br /> M!r Conqo.Exp.BePt 19.2001 Notary ublic <br /> 10-6 September, 1995 <br /> �;�.. <br /> wr , J:� ' �'': <br /> � � <br /> � ��. <br /> �' . . �.�'-. i 4k <br />��'�.,. ._ � '' . � . _"x iN�.�s��..��' . <br />