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Claim of Lien 200505543 ............................................................................................................................ ............................... State of County of Before me, the undersigned Notary Public, personally appeared _MCA e L S C r- VCw who duly sworn says that he is (the lienor herein) (the agent of the lienor herein) whose address is a !o 0 f Y' a rr d G 1/ and that in accordance with a contract with ) L,(-.) �Z 42P JF cy 2 v, I t" lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials :O on the following described real property in Gr County, State of /1lc CI r k a (Describe real property sufficiently for identification, including street and number: a n d S i 5 S total value of of which there remains unpai and furnished the first of the items on not in privity with the owner) 20 0 :5- by Dollars ($ ) 5 3 c' 34 Dollars ($_ 1 , G' ,_G_ 0 ), on /rte , 20 n s - and the last of the i / , 20 a y._ and (if the lien is claimed by one the lienor se d his notice to owner on (Me od of Service) And, (if required) that the lienor served copies of the notice on the contract on 20 , by (Method of Service) on 20 , by lender , on L d e� s tnc� www.socrates.com and on the subcontractor and (if known) on the by (Method of Service) -Y (I -a ve�(j� sUU fk 3 5'0 10 F a Pagel O 2004, Socrates Media, LLc LF136 • Rev. 04104