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Claim of Lien 20050 5555 <br />State of b S <br />County of <br />Before me, the undersigned Notary Public, personally appeared <br />a 10 �`- C� 14 12 <br />who duly sworn says that he is (the lienor erein) (the agent, f the lienor herein) whose address is <br />rr� bROI l e S o <br />and that in accordance with a contract with Lt) P- i S RLl j ici e n S <br />lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials <br />separately) n 6on �gm Con?Ceie e cc-�02 �c ' &'G <br />on the foil:win described real property in 1 County, <br />State of its k er <br />(Describe real property <br />i for identification, including street and number: <br />, M&n,t4*C4 -5i x-HA 75 lkbCt %V i IS i <br />7U `t H 1 1 U Li V r rr <br />owned <br />by t)a MArt + u(5i,je5 -4±-- of <br />total value of Dollars ($ ) <br />of which there remains unpaid Dollars ($ <br />and furnished the first of the items on 20 p � and the last of the <br />items on T , 20 Q,�-_ and (if the lien is claimed by one <br />not in privity with the owner) that the lienor served his notice to owner on 1;O <br />20 O by MA' Nd �A � � i t � s em �i O n� <br />cg7ic-- e, - e ve&-A) COA AW AJOP.s (Method of Service) (!O e p 6 2 A+e e t C e A&A tO A t- mR 2 <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 />Ij( ei'S &t Ider2s r TNc . <br />ec-`kpo It's r pity. <br />, by <br />014( - lrylkaf- <br />and on the subcontractor <br />and (if known) on the <br />(Method of Service) <br />Peq( P-4A�-- <br />GJ41 YYrAF- '-'40ri'G'S, :AX . <br />40,E ---NIA-1 B+j 54-P I f' <br />&,A,,3vAe , Ar? Kiwsras <br />Page 1 <br />0 2004, Socrates Media, LLC <br />LFt36 • Rev. 04/04 <br />