HomeMy WebLinkAbout95-05220
.'orm A 136 ClaIm or Lion
.ff (jj"- j'2-l.6 ,ttl,D
CLAIM OF LIEN
SUlleof 'Pe(\(\sylvQOia.
County afQLlmberla.nd
55.
,19
nelore me, thc undersigned NOlllrY Public, personally appeorctl ;Tn l'1e -T 6, ::Do \/L'"
II'ho duly sworn soys that he IS (the lienor hcrein) (tbe agent of the Iicnor herein)
(1).,lcle One)
-----------------------c:l~__~~.:l:~__________________________________
(Liennr's Name)
whose address is:35;Jl :<.i m p">m"\ Fern/l<rYv-\ C'arnpJ:ii.\ \ P A I,n II
, (Lienor's AdJreu)
and that in aeconJance with aeonlIUet with ~I\ ~\s ,In.. ,
lienor fornishctl lobor. services or moleriuls ~onsisting of: (Describe specially fuhrieatctl materials sep!""1lely)
5 hcurolo.\:oY'", I Load u:a:\er .5 u.:clev- h:lt!6 6ncI3 ~ cJrSICx:.K
on the following dcscribed real propeny in ('.-. 'r'fih-,-l->"""'\ County, State ol~n""'llhhnl'a
(Describe real propcny sulficicmly for idemificatian, including succt and number, il known)
q ID Allen :::J"=+ Ne.w Curnbedard 'PA 170,0
awnctl by t:l,,,, I Cw
(
of a tollll value ofRv,. h 101m-! pi3h\)i+hnoP
olwhich thcrc remains unpaid S 5'8::=3,--u.
dollars (SS'R3."1l
, and fumisbctl tbe first of tbc itcms on
"'J:i'\\l I~
J
,1995-andthelostoftheilemson 01.1\, I;:;), \qqc::;
I
and (if the lien is c1aimcd by one not in privity wilh thc owncr) that the lienor scrved his notice to owner on
:\, I \'1 \~
,
,1995-, by l-nnrlinj ~ CCW('l C'~ynP i.,vni"...
(M 'thod of Servic )
and, (if rcquircd) that the lienor servctl copies of dIe notice on the eammetor nn R - 7- C)c:; ~ q - '7 _q "')
by..-sm""r"I"t"I"It-.., hXv I :>TCICl."YItnn i I and on die subenlllractnr.
(Method of Se Ice)
on
.19
, by
(Melhod or Service)
(' -rY'Y\a \I T-hlbInC' .
Licnnr
n y jh m01__,4. [':1-) n ~'~_______________
O-~ Cl ARenl
Sworn to and subscribed before me Ihis ,;2tM.d. duy of Q ~ 11 )
.193.5::.
o ~~JJ~~~W) I ,
f17mA ~~li0
My Commission Expires:
r'()t '_~'.;,: ':,
1:"",-
11;:'(
; n r.\
c. E.Z Legol Forms
Ci,',
M'I ell',",';
c._/ , ',i: } ~_Ci.. i, ~Ji n. l!i~1
-------"
)
U"J
en
-
~..; ;-
.,
..e
(>..
...;:J
,~
r.;"J Q
QQ ........
~ ".
-~
'"
Lt>
a)
c--J C\~ ~
... '''"''- ~
'-'
=
tl
~
p ~
i {
o
~ f
~ i