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<br />1NSTRUCTIONS: <br />(IJ Jf the liege u claimed by a Frm or corporation, state Here that a,~eant is a member of the jrm or hes <br />o(jicial capacity in the corporation. <br />l2) State here zerhether verbal or written eontraet. If written, attach copy, or lien is void. <br />(3) "Erection," "Construction," "fJlteratioa," or "Repair" as the coca may be. <br />{4i here insert correct legal description of land. <br />{~) !j the Eabor and material were furoeished the contractor and not the owner direct, state "that .................. <br />was the contractor an soil building and acting for the owner." <br />{6) If note has been given, say "said amount is further evidenced by a promissory note, a copy of said Hate <br />being hereto attached and marked `Exhibdt B:" <br />~ ~:.° <br />,t ~ ::.. <br />4. _. ~~ .~.. _ . <br />~~ <br />~# <br />1 <br /> " <br /> <br />i LV <br />`A co <br />1' <br />P C <br />!-. <br />~ <br /> ~ <br /> <br />ea] ~ ~ v <br />~L ~ - ~.. <br /> <br />~ } <br />~ <br />' ~ a,j <br />~ <br />~, __. <br /> _ <br />, <br />} <br /> ~ .tea ~..... - : _. <br /> <br /> ,.. w® <br /> <br />h <br />~ ~ <br />~~ <br />` ~ ~± <br />i~ ~_, <br />a~ "} <br />