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<br /> CLAIMANT: CWiIMANT CONT�ACTED W1TH:
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<br /> ' BERVICES OR iV1ATERIAiS FURNISH�D B'Y CLAIMANT: ....�—.�...�5.'.��LU..�..�......9t....��..IV��F•••S�!-.•••--••-•.••••••••••••••••••
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<br /> CONTtlACT PRICE: �.��7LZ.�,U..�?.............................. AMOUNT UNPAIU: $........Q...���Q.....................
<br /> TIFLIE I.AST BH;RVICES OR MATERIAID I�URNIISHEU: .....hT.�Il��.�....../...7.....1...�.9�:.�.................�...�.-...........................
<br /> Stats of.................. ... . ............. CJ T����p�,��`:�'...�r�:��%
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<br /> `((�..........Coanty� Bi urc of C1ai�Kc4nt
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<br /> , � ............�,,�,,,�...........................................19.._�:�6efore me a Notery Pu�lic in nnd for
<br /> enid couniy.pereunully came�4-�1..�....2�'.lI..,Gl.(,,..................................................h>rne known to be the idenkical perean or �
<br /> pereon� who eaecated thv fureqoing releuee, and acknowledged the enme to be his. her. or thoir volunt�ry a�t nnd —
<br /> deed. .
<br /> �q{n �,�, nty,the day nnd yenr luet n6ovc written. _
<br /> � CENER�tN01AAY•SqS�dMt6r�ttt /
<br /> - MI1RiY BEMDICK,,OH ... ..... .... ...... .•.r-�•�'�'r�"...... °
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<br /> . ���� �� � Notary Public. _
<br /> My conim(saion expires tha.............�...�(dny o£............... .l.J.....[°rl...:.,............� 19.`�_..�. _
<br /> STAT�OF.................................................................... C�itered on numertcal index and filed for record �
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<br /> County of...................................................................... eB. tn tho Register of Deeda Og'ice of eaid Countgr the i=.
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