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<br />r ~=srxuc~ro~s: <br />(r) If the tiers is riai~sed ay a or corporation, state here that a,~tas€t i~ a ttsettsber of tke ;tr~m c~r~ ieis <br />o(juiad eapaesty~ in ties eorparation. <br />(aj Stye hsre mitether veYttal or xwstteu c~trart. If zwittea, attach copy, ar tiea tis void. <br />(,~} "Erection," "Conttr>frtiose," "slfteratian," or "Repair," as the case may rte. <br />(~) Aere insert correct teriat desrrspttaa of land. <br />j~} Jf l tabor' aetd t~rate'rial a fa~vhed tke corstractor ami zot the €r~tiar wee#, stag `:kat---_..--.__:... <br />~s the taufe'gt'tot ora said btcitding and aeting far the o~ttner:' <br />{6} Ij tote has been giz~ett, say "said micoemt is fteriher evidenced by a promissory trots, a copy of safd note <br />btiug hereto attacked and- marked `Exhibit &"." <br />