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<br />NOT!C& IS tlEREBY GIm that ~~ d', 9rif(~~~"
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<br />City of A,d",~I ,4J~ ,County' or #a~. i~1late;'~~"
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<br />J who$e addr'essis
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<br />THAT labor, services and materials and investmentswere.'e~emt~vorif':'
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<br />THAT the amount Claimant demands for the labor, servicelil,
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<br />and investments so expended is $
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<br />Y (J-C)
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<br />THAT no part thereof has been paid, and thers is now due andremainiO&
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<br />$ .y c'-O.
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<br />deducting all just, credits and offsets, the
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<br />1...'1 which amount "?}L-~_4 ,'-t: q~.!rt~,,_~ lA>b~_"
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<br />sum' of
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<br />unpaid thereon, after
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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
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<br />STATE OF
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<br />COUNTY OF
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<br />Subscribed and sworn to before me this
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<br />day of
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<br />Witness my hand and official seal:,~:
<br />Notary
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