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<br />Claim of Lien ............................... I ........ I ......................... .......... I ......... ...........
<br />ltz�
<br />State of Ee)c45r —'I
<br />County of L-
<br />Before me, the undersigned Notary Public, personally appeared , r FJL%
<br />who duly sworn says that he is (the lienor herein) (the agent of the lienor herein) whose address is
<br />6kA -5
<br />and that in accordance with a contract with
<br />lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials
<br />separately)
<br />on the following described real property in 1� _ County,
<br />State of
<br />(Describe real property sufficiently for identification, including street and number: L t G 4L. _
<br />i
<br />t, -r 1 n�F- Q 1 �-_k ,, , �,J T — , rr� -Sr , h — �[ , %/, 4 i !-iN ("_ , T, C,—Z;) w a.L
<br />I4- ,..Z)-u -".,) . W Ac.c _ . O'n' sN lr— O.l r= ^ iZ-* .S L---.4 . Ur.i , r-t.=- n --i rA: sIF J -o.lf
<br />by F NAM GF _ ao pc-.2 -r �r a . L . L . C _ of a
<br />total value of Dollars $ 241 t
<br />( �� �a )-r- i4i,&4E:; of which there remains unpaid Dollars ($_ - .� ( a-Ba ), p and furnished the first of the items on V"(�4 2 ( � , 200 5 and the last of the} ��rE2
<br />items on of C 20 Q5 _ _ and (if the lien is claimed by one
<br />not in privity with the owner) that the lienor served his notice to owner on
<br />20 by
<br />(Method of Service)
<br />And, (if required) that the lienor served copies of the notice on the contract on
<br />20 , by
<br />on 20 , by
<br />lender
<br />, on
<br />(Method of Service)
<br />and on the subcontractor
<br />and (if known) on the
<br />by
<br />(Method of Service)
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<br />Claim of Lien ............................... I ........ I ......................... .......... I ......... ...........
<br />ltz�
<br />State of Ee)c45r —'I
<br />County of L-
<br />Before me, the undersigned Notary Public, personally appeared , r FJL%
<br />who duly sworn says that he is (the lienor herein) (the agent of the lienor herein) whose address is
<br />6kA -5
<br />and that in accordance with a contract with
<br />lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials
<br />separately)
<br />on the following described real property in 1� _ County,
<br />State of
<br />(Describe real property sufficiently for identification, including street and number: L t G 4L. _
<br />i
<br />t, -r 1 n�F- Q 1 �-_k ,, , �,J T — , rr� -Sr , h — �[ , %/, 4 i !-iN ("_ , T, C,—Z;) w a.L
<br />I4- ,..Z)-u -".,) . W Ac.c _ . O'n' sN lr— O.l r= ^ iZ-* .S L---.4 . Ur.i , r-t.=- n --i rA: sIF J -o.lf
<br />by F NAM GF _ ao pc-.2 -r �r a . L . L . C _ of a
<br />total value of Dollars $ 241 t
<br />( �� �a )-r- i4i,&4E:; of which there remains unpaid Dollars ($_ - .� ( a-Ba ), p and furnished the first of the items on V"(�4 2 ( � , 200 5 and the last of the} ��rE2
<br />items on of C 20 Q5 _ _ and (if the lien is claimed by one
<br />not in privity with the owner) that the lienor served his notice to owner on
<br />20 by
<br />(Method of Service)
<br />And, (if required) that the lienor served copies of the notice on the contract on
<br />20 , by
<br />on 20 , by
<br />lender
<br />, on
<br />(Method of Service)
<br />and on the subcontractor
<br />and (if known) on the
<br />by
<br />(Method of Service)
<br />
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