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[NSTRUCTIONS: <br />(r} if the ken is claimed by a firm or corporation, state kn•e that a~iant is a member of the firm or his <br />official capacity in the corporation. <br />(a) Slats here whether verbad ar tiwrittex contract. [f ugitten, attach copy, or lien is void. <br />(3) "Erection,» "Construction," ".Alteration," ar "Repair,» ar the case may be. <br />(,p) Here insert correct legal description of land. <br />(~) If tke labor and material were furxished eke contractor and net tke owner direct, state "that...e ...:.......... <br />was the coniroctar on said building and acting for tke owner." <br />(6) [f Hate has been given, say `°said amount is furtker evidenced by a promissory note, a copy of-said note <br />~.-., being hereto atlaeked and marked `Exkibit B'=' <br />C? "' <br />o <br />x ~ ~ as c <br />^a. <br />«~. ~ ° _ <br />~' r,,,t C' r' it ~., K <br />y_~ ~ ~ ~ <br />~ ~ ` ` '~ <br />_ ~ _ ~, <br />~~~ ~ ~~ <br />w <br />_._.__ , <br />