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AWL <br />STATE OF N e b I-, <br />COUNTY OF Ha I I 5s: <br />The undersigned being first duly sworn depose_and say—that bX/they, Thomas, L. Jorda, d 21r,­-is <br />L. Jordan, each in his and her o',Wn right and as spo"s <br />(5n, tneh Hlel- ls�aare the owner of premises <br />known as Lot Six (6) in Block Cne (1) in Bel - it Addition to the Cit- of <br />"e b r: i sl - a Civ'71 <br />which-- l <br />has been mortgaged t to secure a construction <br />(Assn. or Coop. Bank) <br />loan for the erection of certain buildings on said premises, and that to his/their knowledge no work has been started <br />on said premises, either materials delivered or fabricated for or labor done to this date. <br />Affiant.further states that there are no judgements against him/them in any court remaining unpaid; that there <br />are no suits ;pending against him/them in any court; and that the undersigned has not authorized or permitted any- <br />one in:.his/their behalf to execute any instrument or make any agreement affecting or likely to affect the title or to be <br />A n u p'40d lands within the last sixty (60) days and that there are no liens or claims that might become liens <br />,6;6 fm' cept the following: <br />I A, <br />7", <br />tc 0 M fif f <br />0 rl <br />1-7 E X P i R C S <br />Of <br />09,ow,* "and <br />with naught. <br />Owner <br />67 Owner <br />subscribed before me this l 5 t 11 da V of <br />Not roublic <br />My commission expires f 71' <br />BY CONTRACTOR <br />STATE OF <br />COUNTY OF 55: <br />The undersigned being first duly sworn depose and say— that:Ke/they, , <br />"X/are the general contractor <br />having a contract to construct a n the premises <br />known a3 L n t SJu� in 3I(_)c!'7 2'jn 3-"1 - d t'f) 2 r <br />7 <br />mortgaged which has been mor L ffe (I T -to secure a construction <br />_� - ' ; <br />­C ­ '�I 1JO. .. (Assn. or Coop. Bank) <br />lo*4or,,the erection of buildings on said premises. Affiant further states that he has furnished a true itemization, of <br />irubtion costs at this time, same to be used for labor and materials on said premises. <br />states at no labor or materials, prefabricated or otherwi av en used o ar fo <br />. that <br />es to this date. <br />with naught. <br />J" <br />Contractor <br />7 $w4n"W."' d subscribed before me this l 5t h day of 19— <br />Not <br />r Ma 't 11:20P. <br />My commission expires Filed ecof�d Y19, Iri 4� bliL <br />r"M CIA Register of Deeds, Hall County, Nebraska <br />