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<br />84 -00360<1;
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<br />,22,1,,~_~~~~_~~~N.j~,:S Li E~ (Revised 1962)
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<br />rho' H,lf'fmiu G~;jH<l~ ;~1..iH,;; HQUk, LmwJn. ~"'e!:f.
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<br />Lien claimed by.' J.u~x.2. ..J9.~4,..
<br />..,J?Jo!f\l?9.I1...&...Knll,t.h..p.r.YW9J,J, .0..,1.,. J1)9." Against. n~98-~yi:ie~...~~J.9P.r@.tIt ...
<br />Address":PQ.f5.,$,,...BC?lJ~.J2fty~.. 4196 Arizona Avenue
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<br />_h.._~~...___.L.J::~=~n:..~~~:;___(y-~~iL~_~._.__.:'_~::__~~~=~=~5:!i0=t==:
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<br />State of.,....,~~I<!'. .l
<br />ISS.
<br />___..l:U\LLnm_m. CotmtyJ
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<br />Affiant', . u....J?!Jim~mfi".~,..rxS',l2ident..QLsaid.,coxp::lratian....,.. .,...,.'.'u.'m..n.., being first
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<br />duly S--...rJorn, on his oath says that the foregoing itemized CU'count of work, labor, skilL.._._. __,,_..W.....un._..____um_.__.._m..nuu.
<br />materials, and improvements ;s true and correct: that same 'U/erc done and performed and furnished by the undersigned
<br />far the said..c;..c:..,~l)E;~~'=13'c!()\\T<iJ'11<2:.?'j(:)~<:.k. '''nnun.n......nn n.....n..........'nm..'n...............
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<br />under a~ . .uQb.~l_... cantt'act.n.=_. on"" .__ _.._____.._..__.._...............
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<br />jar tiles..
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<br />.un.u____...........of a .
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<br />on the following lot, piece or parcel of land, t.;=;'. ..L9.t..f.iv"" ..C;;;,L.,.LaIre...D.av.is,.,'l1lird..SUbdi.v.isiou....................
<br />Ha~~.CXJ1ll1:t::y:, ..l\lEObra~.. .....,............................'..m..
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<br />That at the tt)~te said contract 7('OS ~nllde fInd labor and materials furnished and delivered thereunder.___..............h.h.
<br />....qlCit.<=<2ltl Orleans Deve~()~t,c:/c:>\'i'<3.YJ:l<=...~~l.<::J<:.. .,was the owner of said premises'
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<br />That the date of the ,h,st item furnished and delivered was.1lf'PE()~~ly...:E'~..1.,!...:!:9.~;~...., and the
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<br />date of the last item was.. ,1'>1cll;''"I1...3,L,..1~,!!.'1..... .m............... .. . ............,.. .....,..,.,.................,................,..
<br />Affiant further states that said laboT 'Zoos performed on, and materials were furnished for, delivered at, and used ,in
<br />said building or premises on tlnd between the dates specifitd,
<br />That the ilri.ces charged therefor are fai,. and reasonable, and that there is now due on said account the sum oj
<br />.. .....Clr1<ol.,1'h?~~.. F()\lI'.HlU1C1J::e.c.t..lIr1c1..~l~()O,.::=::::..::::=::=::..=:::-.::::::=::::::::::===.Dollars, that said'
<br />..E:J~1l.>3()l}.. &...I\l}ll1;b,.~ll..c::q,.,...J!}G,.,.. .,..................,...,.""........."...........,..................
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<br />"!n.i~.. /1 l;i'~ ,...~ fl-.~ -:-:'':1 t"'':7''l-~ir-::: :77 !.":.z ;:.!: ':;i;,J;;i;t vi
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<br />said account, to-tl.l'it: The sum
<br />from the.. 31st ,... .do.,. of.-
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<br />of $..:j.,.4D.O~.QO..,.........,. ,...together R.;th interest thereon at the legal rale,
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<br />fur;~ 9V ~ '-f, ,~f3.4 " ,'nar fltrther affi~~t ,~~y~..~:t,'
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<br />J:~~'SlaI..fNobtt'b Subscribed in my
<br />KARMAN K. WISSING
<br />My 00lIUIl. up, Sept. 11, 19M day of .
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<br />( See r-everse side for instructions)
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<br />presence and sworn tt} before me this.. ..5th..._......
<br />.mJ'4X / 84
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<br />STATE OF
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<br />Entf'n'-d (Ill r1LllJ1t'.rh'a! lf1(Jt:.X and tHed f"r n'l'~ird
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<br />County
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