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20120461� <br />Recording Requested By: <br />M�.rk H. Foss <br />When recorded return to: <br />Mark H. F'oss <br />Ge�ePal D�liverf <br />Gr�d �slead, l�ebraska 68801 <br />CLAIM OF MECHANICS' LIEN <br />1. M �"� H •���� doing business as tiz-�t � <br />claims a mechanics' lien on the real estate located at the following address ��3 ea�t 16th, st. <br />1�3 eaat 16th stre�t <br />�Tsb�aslca and in the county of ��` <br />or reputedly owned by Armold H. Fo�s <br />which is in or nearest to the city of �r�d Isla�d� <br />��b�"��1� This property is owned, <br />, whose address is 103 eai,et 16ttt� et. <br />103 eamt 1 bth otreet G►rar�d I slarid, Nebraska bg801 / Lot .�ive ( 5) in Block <br />Eig t our e� ar vnme ;� o o�, o • �� <br />o! QraBd I�lud, N�braaka. <br />2. This lien is claimed for money that is due and unpaid for services and/or materials provided at the request <br />or employment of M�k H. Fo�a� . These services/materials provided were <br />generally the following: ��pa,��,�� �� p�p�r� 1,e,boa�. <br />Wood� r��r toilet,�sw �ub sur�ou�nd, wa11 pa�eh m�,teri�l.s, pa�At/b�ns�es ar�d <br />tro er�, a� a r. <br />3. The amount of money that is due and owning is $ 1� � , after deducting all offsets and <br />credits, plus interest at the rate of �� % per year. The money became due on Ju�1e 1 st� 2011 <br />Date: / � O / � <br />I Mark FI. �o�s <br />� �� F� `;'D'=�� <br />Claimant (print) M�,rk H" Fosa <br />VERIFICATION <br />am the claimant or the claimant's agent authorized to make this verification <br />on the claimant's behalf. The foregoing statements in this claim of lien are true and correct based on my own <br />knowledge, except for matters stated on my information and belief, as to those matters I believe them to be true. <br />r ' <br />Date: t� -' l/—�i C� l 2 �� ��� <br />�. � <br />�'������ pN Claimant rint M H. Fos�i <br />RpNq1.D D PEf ERS �P ) <br />. �, �, 28 2018 <br />, 14�� / �� � // ��/ <br />G�� <br />✓,Z2�� ��%��� <br />