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<br />F <br /> <br />INSTRUCTIONS: <br />(I) If the lien is claimed by a firm or corporation, state here that affiant is a member of the firm or his <br />of!kW1 capacity in the corporation. <br />(>)Sltite fWre whether verbal or written contract. If written, attach copy, or Ii... is void. <br />(j) "E;oectWn,""C Ollsfnuh"";' "Alteration," or "Repair," as the ca.re may be. <br />(4) HM"e insert correct kgallkscription oj land. <br />(5) If lhe labor and materio:/ were furnished the contractor and 1IOt lhe owner direct, slale "Ihal.................. <br />W4S lhe .contractor on soid building and acting for the owtIM"." <br />(6) If.;1IOte has bsengifletJi say "said 0_1 is further evidenced by a promissory note, a copy otsaidnale <br />beiAgher&toatliu:hed and _rked 'Exhibil B'." <br /> <br />..-., \... <br /><-' <br />'<" <br />~. <br />il <br /> <br />~ <br /> <br />'\ <br /><;1 ~ <br />..~~ \ . " <br />'l\.'\, <br /> <br />.:; ~..~I~ <br />:. N''''i~- <br />~.. 1.1), -1 M~ <br />~tQ !l~l~-' <br />~ 0 C. :f'~NfY. <br />P 0 g_ ~ ~ J ~ ~ <br /> <br />c:c <br /> <br />, <br />.' <br /> <br /> <br />~ <br /> <br />" <br />"'..,} ~. <br /> <br />x;:: <br />.a: <br /> <br />'" <br /> <br />c <br /> <br />'" <br />II) ;, <br />..,,; <br />err- <br />~~ <br />.... <br /> <br />ll... <br />r. <br /> <br />'-' <br />~ <br />...... <br />- <br />. <br /> <br />\~ '" <br />:;. <br /> <br />t,;,,: >-- <br /> <br />~ ,_',1 <br />I..'} <-'" <br /> <br />L <br /> <br />'$ <br />