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<br />NarIC~AISHER~~ OIVEN ~hat 917~~(71~~_./~~<.,
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<br />City or ,,-y/CL....d ~.r<./~,.,~. ,Count.y of /~ ...... .......~s~c!t'~?
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<br />'?J{L-1 ~~J~ .' cla1ma alienond~-dt~b~.> ~Y;i;
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<br />THAT the owner or reputed owner
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<br />under'agrant'of. trl!st'is
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<br />, whose address 1s
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<br />THAT labor, serVice,s ..ill" malen.:-';''; and 1nv9stmentswere expended on
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<br />said property between
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<br />/ /-'5-'9'
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<br />and
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<br />THAT the amount Claimant demands for the labor, services, materials,
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<br />and investments so expended is $
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<br />:r ;;? at) ~ ~
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<br />THAT no part thereof has been paid, and there is now due andremain1ng
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<br />unpaid
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<br />thereon, after deducting all Just,credits and offsets, the sum'of
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<br />7' ',1- ~:..- in which amount ,.,<6".1"'h',....h,(,.z4
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<br />$ :/
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<br />claims a lien on said property.
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<br />Dated this
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<br />day of !e' '_'[.~"'_
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<br />, 198:f.
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<br />STATE OF
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<br />/JU.t'ir-
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<br />iid(
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<br />COUNTY OF
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<br />Subscribed ana sworn to before me this
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<br />! ~ ,z( day of
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<br />,/,Jl~_
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<br />1961-
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<br />Witness my hand and official seal: ,:{uj;,~ ~~,Q;..
<br />Notary ,u ic
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