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<br />'I. The real estate subject to this lien is:' Iv- ~Of+h C~~2:)\-oQ LoA:- CJD Ci; V\(~'Sotdh 6JU I
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<br />2. The person against whose interest in the real estate the lien is claimed is: C:... \ u:, n -+- (\,,, N..>.. i I J
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<br />3. The name and address of the claimant is: f'n,~ h s. ~ t' L~~ q_ ~~V ~~'J'J'~ CtL
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<br />! 4. The name and address of the person with whom the claimant contracted is: DO/?/la d.. ('a. If/If, T
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<br />I$TRUCTION LIEN
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<br />5. A general description of the claimant's services performed to,~ be performed or materials furnishj:rl or to be
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<br />CONSTRUCTION UEN
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<br />6. (Complete one of the following)
<br />-L The amount unpaid, whether due or not, to the claimant for the services or materials is $
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<br />_ The unpaid amount is not fixed by the contract, but a good faith estimate in the amount of $
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<br />7. (Complete one of the following) ,
<br />I ~ The time the last services or materials were furnished was I /Jjl!l}lOo 7
<br />! _ The time the last services or materials were furnished has not yet occurred but is estimated to occur
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<br />(52-147. See 52-148 for amendment; 52-149 for assignment; 52-137 for recording time; 52-154 for discharge or release).
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<br />Subscribed and sworn to before me this
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