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<br />r <br /> <br /> <br />JNSTRUCTIONS: <br />(1) Jf the lien is claimed by a firm or corporation, state here that a/Jimtt is a member of the fir~or his <br />official capacity in the corporation. <br />()}'Stiftlfkere whether verool ar written contnu:t. If writttn, attach. copy, or lien is '/loid. <br />(3): f!-i;tNCi#in/f" f'fCf11isinuiwnt HAlltfiGiWrir or uRepuir;i1 as the f.ii4e:miry -be. <br />(4)H~tI if!sert rorrect kgtll description of land. . ... <br />(5) If thll lob"" aM _Uri41 wm jUf'flisMd the contractor and nottM. owner dlrect, .statll "thaL"n,n,,,,'n, <br />,_thll c<>>ilrUctor (}11. said build;"'g and ading for the MelIIW." <br />f1J).. lffll>tJr Iuu. .I>tm. given; say "said /1fJttJfI1Jt is furl her etJidenud bya prIJllussoryntJte, ti tlifiyofsaillnJjf,l <br />~'li.,iFitlItH:W titiiJ marked 'E;:h;bit B'." <br /> <br />;~ <br />11 . <br />~ <br />i <br /> <br /> <br />