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<br />INSTRUCTIONS: <br />(1) If the liell is claimed by a firm or corpora/iot" state here that affiant is a member of the firm or his <br />official capacity in the corporation. <br />(2) State here whether verbal or writ/e'l contract. If written, attach copy, or lien is void. <br />(3) "Erection," "Construction," "Alteration," or "Repair," as the case may be. <br />(4) Here insert cOrl'ect legal description of land. <br />~ (5) If the labor and material were fnrnished tire contractor alld not the owner direct, state "tlraL................ <br />was the contractor on said building and acting for the owner." <br />~\ (6) If note has bee II given, say "said amount is fnrther evidenced by a promissory note, a copy of said 1Iote <br />'\ ~ being hereto attached alld marked ' Exlribit B'." <br /> <br /> <br />~~:;i~=1 <br />t'J; I\!?llft on~~ ~ <br />;~t'.-' s.,~,~ ,~!:.~~~~!~~E~~~~t~~~J <br /> <br />I <br /> <br />~ ~IJ1a~- <br />~ ~,~i~ <br />~ ... ~ .~~ ILl :3:: <br />\It r-I~"""~:Z:LL <br />. ,:;;gEb..O <br />C5~~O>- <br />1 ..- ILI~ <br />-... I- Z <br />CO ~~ <br />&5 00 <br /> <br />~~~ <br />i~ ~ ~ <br />~ ~, ~ <br />~ ~.. ~ <br />~~'\ <br />~~ .~ <br />, ~ <br />~~~. <br /> <br />.=r <br />= <br />'" Cf) <br />Co <br /> UJ <br />x:: Ul <br />0- 0 <br /> lL. <br />co 0 <br />m \)\~ <br />L.l.J <br />L.L.. <br />c:o <br /><= <br />.. <br /> <br /> <br />L <br /> <br /> <br /> <br />r-- <br /> <br /><< <br />~ <br /> <br />I <br />t <br />~l <br />(. <br />