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<br />INSTRUCTIONS: <br />(i) !f the diem is ctaimed by a firm or corporation, state here that a~iant is a member of the firm or his <br />of)iriad capaci[y in the corporation. <br />(2) State-here whether verbal or zvritfen contract. If written, attach copy, or diem u void. <br />(31-."Erection,;' "Gonstruition," "tldteration,» or "Repair," as the case may be. <br />(¢) Here insert correct degad descrdption of land. <br />($) If the labor and- fnateriad xoere furnished the contractor and not the Darner direct; state "that..,-:.. .._...., <br />xvas -the- contractor on said buidddng and acting for the owner." <br />(S) I f. note has, been given; sag "said-amount is further evidenced by a promr`ssory note, a copy of sar`aE note" <br />bedng• hereto attached and snorkel `Exhibit 13 :" <br />~~ <br />` ~ <br />~J <br />^~ <br />z ~ ~ ~, <br />v P` ~~ ~' m <br />c ~ @' <br />o a ~; ~ .~ 1 ;n ~'\~ <br />~_ <br />C ~.. ,~ , <br />