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<br />: Lien claimed by: T~~.r.J.A~,:r.y__'~h"__,,,u""h'''''''''____'''''h...,..................19....ae..
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<br />....................'....................... C o~nty
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<br />Affiant>, ...p..I:!.~.!J:!...IjJ.!'!.H....9.r..f..~.~.~...t:'!.~~.~9.~.~....f.9X..f.'.~.!;J~.~lJ.g.~~.f...f.'Jg~.t;!.~DY....~...t!.~9...J~.~........... being first
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<br />duly sworn, on his oath says that the foregoing itemized IUcount of work, labor, skilL.........................................................
<br />materials, and improveme7lts is true and correct: that same were done and performed and furnished by the undersigned
<br />for the said ....Ba\lffiQJ:ui...5...&...C.e1;l;'.1..J.. ..r1a.Y.I1~IlL.............., .............................. ...................... ..................................................
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<br />under a2 ...~.~~,~!:l.~.............................................. contract ...........................................................................................,....................
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<br />for thea .......r.e pair...................................................................... of a ...p.umps...................................................................,............
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<br />on the following lot, pifee 01' parcel of land, vi:;:....I...Q.t....6........alg.c.k...2.6........!!!h.~!l!Jgr...AQ.9J.t.lgf.l...............................
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<br />................................................. ...........--....................--..-.--..--.....-.-..........---.----......_........___......._____.______.._..._..._.._________....._.._..__u........___..___........__..................._.........................
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<br />That at the time said contract was made and labor and materials furnished and delivered thereunder........................
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<br />'................................................................................. '...m................ ....... ,...................................,....was the owner of said premises'
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<br />That the date of the first item furnished and delivered was.....lg.~.~.?::~.7....................................................... and the
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<br />date of the last item was......~Q..l3...81....................................................,.....................................................................................
<br />Affiant further states that said labor was performed on. and materials were furnished for. delivered at, and used in
<br />said building or premises on and between the dates specified.
<br />That the prices charged therefor are fair and reasonable, and that there is now due on said account the sum of
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<br />............................................ .......................................................'... ....claims a lien on the said premises for the full amount of
<br />said account, to-wit: The sum of $J..'Jf1.~.~.L...............h..........................together with interest thereon at the legal rate,
<br />frl)fll the....J.O'ltL.......day of......f.~b.y.i;lr.\l.............................. ................................, 19....eft.., and further affiant says not.
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<br />Subscribe in my presence and sworn to before me this............r:~...........................
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<br />day of .............................~.....;........................, tf,.&(......
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<br />(See reverse side for instructions) Notary Public.
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<br />::~ ~::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: } 85, ~n::~eOg:t:~:;r~:~~n~:c::~ S~i~ ~::n~;~~:
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<br />........ ....... ...day of.,..........,.....,......... ... .., ... '.... 19.....,_..... at........, ,....... ......,...o.c1ock and.................,............minutes ....................,.M,.
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<br />and recorded In 8ook....................................,.....of,..............,........,..... ........,at page.....,......,........,..... ....,'...........
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<br />............,Reg. of Deeds
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