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Claim of Lien <br />..................................................... <br />State of Vr';� �K a <br />County of Gi <br />Before me, the undersigned Notary Public, personally appeared <br />who duly sworn says that he is (the li nor herein) a agent of the lienor herein) whose address is <br />/ Or l 3 ' ra �5� eve <br />and that in accordance with 'a contract with mm LO e 1 S r <br />200505542 <br />lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials <br />separately) <br />on the following described real property in G % County, <br />State of P <br />(Describe real !7 property sufficiently for identification, including street and number: <br />3. Vic a^ <br />_c A 17 <br />owned <br />by S of a <br />total value of Dollars ($ ) <br />of which there remains unpai Z 1r 0() v a v Y, P Dollars ($ 310 <br />and furnished the first of the items on t , 20 S- and the last of the <br />items on 120 03– and (if the lien is claimed by one <br />not in privity with a owner) that the lie or served his notice to owner on 0 - A <br />20 Co — by e ► e�� �Ok, C����yvc� +o <br />0� �, C e (Method of service) <br />And, (if required) that the lienor served copies of the notice on the contract on <br />20 , by and on the subcontractor <br />(Method of service) <br />on 20 , by and (if known) on the <br />lender , on - by <br />(Method of service) <br />7 (a I y <br />► N fj f AV 0 1' -s; M INJ - 6 5 L/ 2 3 <br />Page 1 <br />www.socratesx= <br />® 2004, Serrates Media, LLC <br />LF 136 • Rev. 04/04 <br />