|
<br />::INSTRUCTION LIEN
<br />(f) ""'" ~
<br />~ ~.....
<br />~ 1\~
<br />........... c D
<br />l,-\ '\.~.
<br />"-l\ ....
<br />~'"~\
<br />~ ~ ~
<br />'-:"\;::-
<br />'::::) ,~
<br />~~.~-
<br />~,N~
<br />~ '- "S-
<br />~ b'
<br />'-. ~
<br />::;:.
<br />
<br /> 10 n ~
<br /> m ::c
<br /> .."
<br /> c: m (I,
<br />"'" Z n :r
<br />:t: E c "
<br />.-n !!>>
<br />(") ~ \
<br />11; :::c ~
<br />
<br />I II
<br />J{cob Nortl ~ t1ng CO., ~., ~coln, ~~ -6852~ ill
<br />~.~ 3 ~ ..~ . l'oJ
<br />~~~. ~ ~~ .0
<br />
<br />o c{- N c> "'T1 " 0
<br />"T1 0) "'T1 :z: CO
<br />
<br />~ t~ ~ ;: :;ri ;0
<br />m ::9 r- :;;0
<br />o r- :t>-l'oJ
<br />(.fJ (j')
<br />....... ;;00:: 1-4
<br />....... _.::. .....:J
<br />...r::. CFJ f'\;)
<br />U)
<br />
<br />
<br />~
<br />CS
<br /><0
<br />CS
<br />N
<br />......
<br />-.J
<br />N
<br />
<br />
<br />200902172
<br />
<br />CONSTRUCTION UEN
<br />
<br />~{,J/)
<br />
<br />1. The real estate subject to this lien is:
<br />
<br />511 N P,,,ve 5r. / 6nANO IsLAJ.vO, 1Llt: 69g--0/
<br />
<br />1;-rtJ #Ol1'H Ie Ft3b hi" t.r:.T ? /"" 13.....x e: /9 IN iff!: ('}~/.:.;"vA4. 'S&JAI ,0;:: ~J4NO I'f.t.-AA-ILJ , IIA~U.t"'" 7-
<br />' ,p61!l....~j~ /
<br />2. The person against whose interest in the real estate the lien is claimed is:
<br />
<br />fG~'ih r::~ &l./6V,q..e~ LJ~ -LhF~/l.()
<br />
<br />3. The name and address of the claimant is:
<br />2/s F;.er )t'EA-.bJEfv ~,
<br />
<br />/Y)g, iZ:,nT6tL Pi--JIY/13//'J? f [Jt2-4/~1
<br />,
<br />
<br />Ct>?-19AJO l$~"hV.o, N C 6 ~"8 0 /
<br />
<br />4. The name and address of the person with whom the claimant contracted is: /Y)//. k?~ b TFC/Z P'-V/"IY.NC. ;-
<br />iJ/Z4nv . ;U5 ~lt.r 14::4tZ,u.;y d.; bA..4".JO /5?A.;.JO, NC 6S1fD J
<br />,
<br />
<br />5. A general description of the claimant's services performed to, to be performed or materials furnished or to be
<br />furnished for the improvement and the contract price is: TtJIJL "~T' PeRMIT "fWO LJv.J. '7 '.'1'170.. ~v/c::ti-
<br />
<br />1';,117 (.,),1:> LE4-ILJtJb-, !I/QO 7b &,. p.4 s;.,ue:r E 7j;~ oFF W,4Te!a 4r CiTy ,lV/1'J1"'. Cry /1i4M JIp""e Ci~5
<br />
<br />5;;PMArT {,...4;7FtZ 5icL-4//ce5. MNGO 111~/A.J IN 0", 5;"T~ f J/V5P1U ".J6t-1 WM~/J- St::/2.VU-C ;F wa.e.b;f1
<br />
<br />6. (Complete one of the following)
<br />~ The amount unpaid, whether due or not, to the claimant for the services or materials is $ 700, c.v
<br />
<br />_ The unpaid amount is not fixed by the contract, but a good faith estimate in the amount of $
<br />7. (Complete one of the following)
<br />~ The time the last services or materials were furnished was JAp.JOltl2.Y ). 7/ ,)..,00'1
<br />
<br />_ The time the last services or materials were furnished has not yet occurred but is estimated to occur
<br />
<br />I~~
<br />~a~:::.
<br />
<br />Signature of Claimant .J;!.l5('>,v~' L6.vT z-
<br />()~FJ(.t' J1'1'1IVAe.'#/z..
<br />Me., 12.",.-r6'A- /Lv/'"'{lwp.
<br />
<br />dayof qn~ , ;;!.oD'1
<br />, ~ !2. /5,h /i tLt7 -'
<br />~.. G GEiENfRAlD~~~~E ~~~~~~~Ska Notary Public
<br />~ My Comm. Exp. Sept. 25, 2010
<br />(52-147. See 52-148 for amendment; 52-149 for assignment; 52-137 for recording time; 52-154 for discharge or release).
<br />
<br />Subscribed and sworn to before me this
<br />
<br />~~M
<br />
<br />__][1
<br />
<br />Rev, 9/9
<br />
|