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Claim of Lien <br />......� ............ ­­ ...... <br />/ l� <br />State of rCt S o, <br />County of PA( L <br />200505544 <br />Before me, the undersigned Notary Public, personally appeared so5e (�),n C % Y, <br />who duly sworn says that he is (t lienor erein) the gent of the lienor here t) whose address is q 0 1 <br />and that in accordance with a contract with �Ik1 <br />lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials <br />separately) <br />ki, 0L YZ4 'r-Q. - ki� u y <br />on the following d scribed re I property in _ �� �L �• County, <br />t <br />State of e iCi S Ka <br />_0 <br />owned <br />by a V=eal c (I C_ ; Wfn=f of a <br />total value of Dollars ($ ) <br />of which there remains unpaid /,S 30 %!9 °/a i n e v e5l Dollars ($ /; 4- 0 3 <br />and furnished the first of the items on M 0 v Z 3 12005 and the last of the <br />items on _ _ ,v ,N I (, 20 6 r and (if the lien is claimed by one <br />not in privity with 0A owner) th t the lien pr served his notice to own r on OC-1) <br />20 a by u\ r 6qtS �YVC.0 OLI <br />(Method of Service) C-) r 1 r Q <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 <br />,on <br />and on the subcontractor <br />and (if known) on the <br />by <br />(Method of Service) <br />ale's �jUNeY5, rnc, <br />%6q3-LyJ46-fe AjenuC soC.c_Th <br />AIA1,55 ��3 <br />Page 1 <br />www.socrates.com C0 2004, Socrates Media, UC <br />LF136 • Rev. 04/04 <br />