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I OHI�t G <br />CI"I'Y Ol' I:\%i;l:lC i 1 <br />Sr.��l�uinish C:uunty� AVa.�iiint;l��i: <br />UNS�il� F. P,UILDINGS REFFRENCL NO, �- '/�- —�{ � <br />S'1'A'I'1' OF' \I'.',SITiNG"I'O`, ) <br />� 5S� � ��L'Fll)AVI1' Ol� Si,:!tVICP� � <br />' � COUN'PY �OP' SNOI1t�D7Iti11 ) �� <br />'I�l�i� und,.r,:i�n�•d, L�.�int fir�:�l <lul�: =�:�urn �,n ��:ilh� �I���io_���s ;iurl =:i�� s: <br />1. '1'h+it i�i and during all ti�ncs hcrcin mentioncd� affiant was :ind n�i�: <br />is c.•:rr ihc a��c of tt�enty.-onc ycars� n�:itizcn of .thc Unitc•d $tat�s. a resici�_nt <br />nf ihc Slalr of�Washin�lon and'compctcnt Co b.� a wilnCsS hcrcin. . � <br />2. '1'hat affiani :�c•rvcu a full� truc� corroct duplicale origiiu�l ���i �� <br />ul' ih<, follc��•in�; �l<•scriLc•d documcnt: (Cross out inapplicriblc nutii �) <br />(:�) �OTICL OF iINSAP'F. }lUILDING(Sj <br />r �.- nnrcrv.r�emt�n� r.�- <br />( I ��--AIi�? -IFrr»�-.�mvrr-cr'�i-�7-1-}-ri�-�i Ci <br />v`�� ,`��vv'�=1i�'{'�'�:�jiJat(�1--i.���u <br />-4F.�-0�SFFi1.. <br />�;c) 1�'OT3C�-9F ,-�'�'rr`���,"•"��f2$i:-H' <br />A copy of which is attacLcd hcrct�, ��nd I��� th�r, r��f� r� r� � <br />madc a parl hc�ri•in as �h<�u�h sot f'orth in Inll li�i•rii: <br />npon �acl� of th� fo1lo��in,R, last Icno��;n o��nc:•(r;) of <br />rccord of thc buildin�;(;)� nr su•ucun•c�(5)� or portiou(s) <br />Iliorcof dcscribcd in said dnrwnont l;y tho mann� r sot <br />foi•ih hcrcin;,ftcr: <br />(�i) PI�RSONAL SI�I2VIC1: <br />}3y dclivcrin� and lcavinq ::��ri � ui��: �cith r..iid o��:n��r(=) <br />al lhc placo and timc srt furtl� licr� inl,clu��•: <br />O��n� r Nainc� AddrosG Si•r��cd D:+tc Sci•�� cl <br />:r1 <br />