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4} _ } 22t-A-~6tfCItAtVIC'S LIEN Rottman axd FNtan & WeN, Wat~q tie 58Afii _- _~.
<br />I.itn clastwsd by:
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<br />___.._._..._..d ~eAw.S.i.-_.au.sex.._atfen+w-----.,.,ra~.i..:.i%®-.city
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<br />-L:_Sy ~.j_~_ ..`_~ ~'~_- t't~1._i ~ " ~"' u.~
<br />State o ..... ~..w.., a,s { ~
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<br />i duly sworn, on his oath mys that the foregoing itemized account of work, labor, skitl ................__-.-...----•-.-._----.---------•°---- ~ ;:
<br />materials, and improvements is teat and correct: that same veers done and perfosmed and funtuhed by the undersigned { '.
<br />' for the said._.~?i~:..
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<br />under a' ---..;.."i_..---------°--- -contract .:..~.;.:--._~t:_.:~,:..4..~....~~._._.:._, ,.. ~ ';
<br />' for the' - :,.CL;. f ~:..
<br />on the foltmaing lot. piece or parcel of land, vis:'.....rt:: ~ .?_::.. i..::....: --'---`-- -' --. ---'. .:...:.:. ' ......---
<br />`.. $ ..J -:- -.. ... .: ..: e.,,.... i.-.., ..-. .1:.-..:: . ,...-s `5.~.. .K ».;n...., 4. "-...~..:.., x ..: .- .. :.. t ;..:.u....~, ..,~..;.:... .~..s..4...:
<br />That at the lima said contract urns made and lobar and materials furnished and dR1;yt4red thereunder ........................
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<br />:.- ..... . .....:..._..._s. .__.. ...,... .. :: .. _.. ...,.r.... ..:.-'---..,.Kh..:......_ the owner of said premises'
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<br />That tks dots of the tut item fxrnirhed and delivered was.---.u.:;.C::z...:..:,.:..._ .................°---.........-._--......... and the
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<br />dots of tht last item was.......:'::~........"s......, :.:.:::......._......_.............._.......- • ~ ............- - ......_......................_...............".'....._. '
<br />Afjia+st fta'tker states that said labor coos performed on, and materialr were famished for, delivered at, and used in
<br />said building or premises on and between ehs dates specifeed.
<br />That the prices charged therefor we fair and reasonable, and that there is now due on said account the sum of
<br />,..~ ; ..., .._ .................................Dolkrs, that said°
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<br />...........-- .......................-.-----.._..._._......._..................................._.claims alien on the said premises for the full amount of '~.
<br />said account, to-+wit: The sum of $...~ :..:..:.:...:..............._.-....---_...----........toyetkM with interest thereon at the legal rate, .
<br />from ehe....:~:..:::. ...-day of g ,.:.:.,..,~ and further a~iaxt says not. -
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<br />IMW~IIr-fxu+lrar ............................... .........
<br />yF~~11iL t9~t Subscribed in my presence and sworn to before me thu ~~,f:.G3~.- _ ...................
<br />day of .:: ..~,_:; ,, r
<br />-~-/ /~ ,~ -•4, .
<br />(Sex reverse side-fat instructions) Notary Public.
<br />STATE 01?_._..._ ..................._.........._........._,....._........ Entered on numerical index and Sled for record {
<br />}~~ in tLa Register of Deeds OEce of snot County the
<br />Coaitty ......................._........_.._.:................,............._...
<br />- --'........._...day of........._....._......_ ....................... 19............, at..........._._................o clock and.._.._...__.__..........minutea _._.._.............h9., .
<br />end recotdad iu Book,,....._......._...__....-_..........of....._ .................................at page_.._._....__.._..-..._....._......... ~.
<br />..._-..._ ..........................._..-'--`---._._.._....__.._-Reg, of Deeds i
<br />Hy..'--_...._......._......_........_........___.......... .--__._....._Deputy
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