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<br />INSTRUCTIONS: <br />(r) If the ties,- is claimed by a farm w corporation, state here that af~ant is a metnber of the firm ar his <br />o~icwl capacity in fhe corporation. <br />(r) State hers whether verbal or written tonback If written, attack copy, or lien is void. - <br />(,~) "Erection,,' "`Gonatruction," "rVfterataan,» or "Repair,,' os the toss may be. <br />(g) Hare insert correct legal description of land. <br />(5) /f the tabor afut material were furnished tke contractor and not the aw>ter dtred, state "that_:..__........_ <br />wet the contractor on said building and acting for the owner." <br />(d) If note has been given, say "said amount is furtker evidenced by a promissory Hots, a topy of mid sots- <br />Itemg hereto attached and marked `Exhibit B :" <br />d <br />Z <br /> ua <br /> ~ <br /> ,. <br /> <br />CS ~ <br />(~, a _~ <br />i ~' <br />~ ti <br />~ <br />"~ ~' ci <br />~ ~ <br />°~ ~ <br /> f ~~ ~ ~~ <br /> ~ ` <br /> <br /> . to [~.V (+~~ <br />w <br />