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<br />1. The real estate subject to this lien is:
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<br />2. The person against whose interest in the real estate the lien is claimed is:
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<br />3. The name and address of the claimant is: -] 0( J '1 l.: Yl 0; '1 'k I.,
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<br />4. The name and address of the person with whom the claimant contracted is: (;;,',. J
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<br />5. A general description of the claimant's services performed to, to be performed or materials furnished or to be
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<br />_ The time the last services or materials were furnished was
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<br />_ The time the last services or materials were furnished has not yet occurred but is estimated to occur
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<br />Subscribed and sworn to before me this .I Iv ~ i/).) -. d~~. ! -:- ,'1:;;::: Ju
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<br />(52-147. See 52-148 for amendment; 52-149 for assignment; 52-137 for recording time; 52-154 for discharge or release).
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<br />Rev. 9/951' i i
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