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I . y�93 5. �c��. d F_ s'S�D • �..�:� <br /> (b) The aame oY the person against whose interest ia►the real eseate a lien is claimed is: _- <br />_ �..,.� � � i � //�l rce. f� LoNn,��<r�i Dt3a i��/-1 T!'eNCL�i u��e_--' _ _ <br /> • � M�d l nd f')'Jp l��c ls___L��•• _ <br /> i�• (c) The name and address of the claimant�s. ��, a �� �, j�� _ � <br /> :�' .� .. '�� �i 5 /_3�'�.ur� � o z n`� 4 �w- <br />� ' �� �?; (d) The name and address �f the p:rson wi�whom the cla�mant�c/n�u�aC�,ted is�'.� y ���£ ���o� �_ <br /> �� � l, .r��� - l�A B�'llarnN !3�_�iL� .;�� <br />_ i; =��� rformed or to ce pe r fonY►e d o r m aterials <br /> ;;.� ;�;��:�:' (e) A general descripdan of the services pe �...r„�;.,� ste e. � '�� � Rs6esso2�P- �. <br /> :��: ���:�.; �:�� � �'. . fwrnished or to,be furnishec.l for the is�nprovement is: __ <br />,�:.�::,�,:,,�. ' � TRIm � ' _ <br /> ; . . � — <br /> �� r���,, '. .. ____. <br /> and the contract price thereof is: S �a a� •�3 <br /> �-'���`"�-'~ � ' (f� The amount unpai�,waetnCr�,�a:�ue. to*h���ai,�nant foz the servicts or materials <br />---��..s,,,.; . the contract a good faith astimate <br />__ :;'��.�• .,<i ,J'' ls. �c��.o i . 8 3 or if no amouat is fixed by <br /> -�"`'�::r%' ,.;{, af the amount designa t e d �s a s i e s ti m a t e is: S �i- i� -9� — <br /> ; ;•;;��s; <br />�--����:.�',�,�r (g) 'T h t t i m e t he las3 services or materials were furnished was: <br /> _...,:,.rT<<. <br /> ---n:ic�:'i t1.:�. 4 . <br /> _--,_,,r;���,�; , a r i f t hat tinae has nnt yet uccurred, an estima t e o f t h e t i m e i s: <br /> —_:_;:_���A ; , The name given in t he lien i n a c c o r d a n c e w i t h t he r e c�uirement <br />---.,;;:.;�,ft"a�� <br />__- ._t�,,., .�,�. ; I o f(b) o f t h i s f o r m��n owner s inte est at the ti4ne o f recor d ing t he lie n�f the recor <br /> "`Y`��' holder of the contra g -- <br /> n.,.,�:>�r � ; 19�L. <br /> Y.-."`�a�`� �s., �t�, �y of��'� p`r' , <br /> ------= Dated this the , — <br /> - .....�.— � "/ >.�t�/r���1 �J � �,�'�' <br /> __.. ::��.'�;"� ' � Claim t. .» <br /> - _:,�;��� � ay <br /> -�_:�'.`�'-r.�"�, � Signature � <br /> --,_� ' � ,�,,*��`x""'"`e"� <br /> -''`°`�"'— STATE OF NEBRASKA, <br /> � u. <br /> � °��� COUNTY OF <br /> ..-^9"z,:.f(�:.�,� � <br /> -..,rw�u���Fll±: :� � � t <br /> =_°::V',�- . 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