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r) <br />rr <br />z <br />= a <br />M cn ° 01 � o n'1 <br />c- Z M CD <br />n:} O <br />4 p 'Ti N <br />tv {, CL <br />O <br />O -T CA) <br />rn —D Cal O <br />COr-1- <br />7K � <br />CD <br />co <br />Z <br />LF 136 -04 <br />CLAIM OF LIEN <br />State of <br />County of ���� SS. <br />1 <br />r <br />Before me, the undersigned Notary Public, personally appeared Z_ .-, A� 1"7 ; -k,/Z- <br />_who duly sworn says that he is (the. lienor herein) (the 11-111 trl Ih. lu nu lirn in l <br />Ali- <br />(Ih:lrtc Unc) <br />a K <br />(Lienor's Name) <br />whose address is <br />-- (IJenor's Address) <br />and that in accordance with a contract with K-1 / '- n- T _ . ti <br />r <br />lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials sepiwilt•IN I <br />lopr _ � <br />on the following described real property in _���_ -_ ___--- _ -_ - -- Couuly. <br />State of Lc� � r ,- 5 /re — <br />(Describe real property sufficiently for identification, including str4�a od- gunib", It known) <br />rs <br />�1e- c- -S <br />Ci 19ti2- 2001 11.*Mnegal Forms, Inc <br />This produce does not constitule the rendering of It.gal advice or scrvices.'I duct is intended lilt. inlonnatimull uec only anti i" wa .' •.ill, iiinir Ian I,;•:�I <br />advice. State laws vary. so consult an attorney on all legal matterz.'I'his pto'k, N.�. not necessarily pr by a prr,vun liccmcrl u) piai urr I:n� ni rims .i:nr <br />I <br />V <br />