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=1X~T~`UGTIi~~,~~ <br />(;1 I~ tba kie~-,,;t claiinrd by a firm ar rorparatian, state here tlrst af~iant is a naeenbrr of tke fssns or -his <br />- ;>'oE ey`=~~hr torparetioa. <br />(~} S1adt here srliether 4>erliat, or ¢nri#tea roatrsct. If retitten; attach-copy, or lien is uaid. <br />- -. /,~} ",Erection;, "L'assstrurtion," `fliterotion," ar "'Krpair," gs the rase +way lte. <br />{~} Herr iuser€ tartest lrgot desrriptian of land: <br />!g} If the ra~,r and snateral zrrrs fr;rstished thr contrar#ar and not the ~-,arxr dirrrt, state "tkat._--------------- <br />uvu thr rantractar an .said baifdiag earl- art~g fo-r -the- oanars~." <br />(6} If' note ka+ Brea. pivrn say "said arnorsnt is fttsther ruidexrrd by a prmnissary note, a rapt' of said state <br />beirry hrreto attarhrd and- nsarkrd `Exhibit B„' <br />{ <br />1, ~ ~_ ! ~ <br />}4 ~' <br />a -. a ' <br />R a -' <br />ii <br /> <br /> <br /> <br /> <br /> 3 <br /> ~ ~ <br /> <br /> <br /> <br />- ., pY> _. <br />