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~ry~ <br />J~ <br />'1i <br /> <br />(t) r:~: s-r~ U e rrc~ ~-s <br />!f the Lien is claimed by a frrn ur rarporativn, state l.era that n~iant is a t~ne~nber of the jerrrr or f~~is <br /> <br />(z) a,~rial capacity tin tkr ~.ar?arats;rn. <br />State here whtthn z.~..-... ct^~itten contract. 1f x~rrrottan, atiut{c copy, or lien is void. <br />(j) "Erection," "Constrnctioae," "rflteration;' or 'Repair," as the case nay he. <br />(~) Here insert :orrect legal description of lirnd. <br />" <br />(S) that_...__.. <br />!f the labor and material :crere furnished the contractor and no! the owner direct, state ..__.. <br /> was the contractor on said building and acting for the owner." <br />(6J !f note has been given, sa}~ "said amount is faortkar evidenced by a prot+zissory note, a ropy of said note <br /> being hereto attacked ar~d ?narked 'Exhibit f?'." <br /> o~ <br />~~~ <br /> ~ <br /> C <br />~~ <br /> <br />Z tti `~' <br />'" ~ ~"~ <br /> <br />~~ i <br />,..6y ~ M <br />_ <br /> <br /> <br />~ 1 <br /> <br />0 ~ Y <br />88 -m eA <br /> <br />~ Q <br />SY ~} su <br />` <br /> <br />] <br />~ ~ J <br />~ a T <br />cJ <br />{~~ 1.'.I <br />~~ C <br />t ~ L <br />- .~ to <br />y ~ ' <br />. i .~ , r ~~ .~ y C <br />~ ~ <br />c <br />~ C3 Z <br />C ~ t3 <br /> . <br />(~ <br />~ ~ <br />° r r; <br />z ~.ii ~ <br /> . ~ _ . 1 =f <br />c t- n s~ <br />~ N U Q? <br />w <br />~ u <br />ti~ <br />c <br />~~ <br />~, <br />~J <br /> <br />