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200505541 <br />Claim of Lien <br />.................. ............. ...... ....................................................................................... ............................... <br />State of <br />County of <br />Before me, the undersigned Notary Public, personally appeared ��� r 'l - ` ; r ue 7 <br />who duly sworn ys that he is ( he lienor herein) (the agent of the lienor herein) whose address is �i Q <br />G ccf�L T <br />and that in accordance with a contract with U Jz <br />lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials <br />separately) <br />M <br />on the following described real property in _ County, <br />State of( 1(�,� <br />total value of il <br />1 <br />of which there remains unpai i <br />and furnished the first of the items on ... <br />items on _ �� ~ ( �—' � <br />not in privity with tN owner) that the lienor served his noti a to owner on <br />20. U5 by .2 I-+�e� <br />CnA <br />(Method of Service) <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 , by <br />lender , on <br />N1 t'AA c ,-- 7G � , , �� � - �Z 3 <br />Vollars ($ <br />. 7 r Dollars ($-.. o <br />, 20–CL�L_ and the last of the <br />, 20 O Land (if the lien is claimed by one <br />.h _C <br />and on the subcontractor <br />and (if known) on the <br />by <br />(Method of Service) <br />Y <br />Page 1 <br />www socrates.com Q 2004, Socrates Media, LLC <br />LF 136 • Rev. 04104 <br />