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~~--=ri- ` <br />TNSTRUCT`TONS: <br />(f j I( the lien is chimed by a firm or torporattion, state Here that a~'iaat is a mernbes o f the j~rm or his <br />o~ciat raputity in the cor¢aration. <br />(zj S`taEf= 16ers wheEhes verbal or sarittex contratt• If wr~ettan, attach coPY, or lien is void. <br />{3) "Erdrtion," "Constrwction," • Alteration,,. or "Re¢air;' as iha case may be. <br />{qj hers insert rarrec! legal description of land. <br />(s} If tlw lobar-and material 2aere furxislud the contractor axs! not the owner direct, stau "that........._.._.... <br />zaas' slue roxlractor on said buildi>rg and acting for the ownsr." <br />{6} -If note- qaa been given;-say "saint anwtent is /arttaer evidenced by a promissory note, a cagy °f card Hate <br />bei+sg heroto attached and- sfearked 'Exhibit B"' <br />~~~ <br />H <br />v <br />t~ <br />~~ ~ ss <br />sa - ~ ` . <br />wi _ ~ 'a° '° ~ ~ ~' <br />cn <br />m _ ~ <br />G1~ c~~z-.~ ~ C r <br />~ y,: ..fry., ;tL^ <br />~P' <br />`~" ' <br />w <br />