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Claim of Lien <br />.................. ..... ................ .. ............. <br />State of <br />County of fi- <br />r1 <br />200505540 <br />Before me, the undersigned Notary Public, personally appeared <br />who duly sworn says that he is (the lienor herein,') (the a ent of the lienor herein) whose address is <br />-�- i o A-�)& X03 <br />and that in accordance with a contract with _ 7 1 S 6') Va 't <br />lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials <br />separately) <br />T V 6- <br />on the following described real property in - aa, _ County, <br />State of - I <br />(Describe real property sufficiently for identification, including street and number:- <br />v SIOI,( / <br />by -IT-- <br />total value of <br />of which there remains unpai!items !on <br />and furnished the first of the <br />e <br />items on <br />not in privity with the owner) that the lienor served his notice to owner on <br />20 05- by r L <br />a1�Sle l��` Lei C (Method of service) <br />ba -d S -o CoWeP, <br />of a <br />M-11 — It ) <br />I, <br />a <br />e <br />And, (if required) that the lienor served copies of the notice on the contract on <br />20 , by <br />(Method of Service) <br />on 20_ <br />lender <br />, by <br />. on <br />Ouddus <br />lM>laaof i > tl� W S 1423 <br />Page 1 <br />www.swatescom <br />and on the subcontractor <br />and (if known) on the <br />by <br />(Method of Service) <br />® 2004, Serrates Media, LK <br />LF136 • Rev. 04104 <br />