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<br />�'�'""' ?;,;�� 1. The�esl�taLe sabjed tfl thislien i� 4���'OF l0� �loc�6 �ann�T�od- /_�,l/�E f�.Pf1�'J
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<br /> ' f����:�' 2 The person against whose int�eat in ti�zeal estate Lhe lien is claime3 i� �--1�
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<br /> .�7 .,�4 � 7?ne name aad addr�of the c]aimant i� /,/�f/��� �_����•�J ?p�� Sz" �7'f'�T
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<br /> �,. . 4. The aa��and addre.sa of the pe��with whom the ' �*� oontracted iR: �— r1 �`
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<br /> :���`�;. =' 4 5. A gem�desceiptian of the c'l�iaaan�s services performed.t�to be p�ormed or�als fumishe�or t*,�
<br /> ; " � ' fi�nishen far t�e impiovemeat and the uontract price i�-� .
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<br /> =::�'�t.}':.'.� •, j �Z`he amount anpaid,whettie:due or na2,to the claimant fox the serviaes or materials is$ ���. .
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<br />:;:,-:.:��" `-`�. ' j �te unpaid amount is not�aced by the oonbad.but a good f�th estamate ia the amount of$ .
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<br /> _,,..��_.�. �_The time the laet ee,rviaes or matezials were f�n�ished was �
<br />- --=�``�f�` _ � The time the last services or materiAls were fiunished has nnt yet ooc�red but is estimated to oocur
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