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Recording Please Return To: Exchange Bank 1204 Allen Drive, PO Box 5793 Grand Island, NE 68802 Affidavit of Commencement (Multistate) Page 1 of 2 cum _ 1.- ,, o - a > z D -4 rV xo nl c o i—% L. ND C; W c s � O c-a Loan- Nnmber: 201125Z11 ` u- cn (TO BE GIVEN TO CONTRACTOR AT CLOSING) AFFIDAVIT OF COMMENCEMENT (Owner and Original Contractor to Complete #5 after Commencement and return signed notarized original to Lender before net draw) C ) 4, 00 Words used in this Affidavit are defined below. Words in the singular mean and include the plural and vice versa. "Original Contractor" is "Owner" is JoAnn K Oseka "Property" means the property commonly known as 3820 Warbler Rd, Grand Island, NEBRASKA 68803 "Lender" is Exchange Bank and its successors or assigns. BEFORE ME, the undersigned authority, on this day personally appeared Owner and Original Contractor known to me to be the persons whose names are subscribed below, and who, being by me first duly sworn, did each on his or her oath state as follows: 1. Owner is the owner of the Property more particularly described as follows: Lot Six (6), Block One (1), Summerfeld Estates Fifth Subdivision, in the City of Grand Island, Hall County, Nebraska and more commonly known as: 3820 Warbler Rd, Grand Island, NE 68803, on which improvements, generally described as follows, are being constructed or will be constructed: 2. The address of Owner is :3204 Magnolia Ct, Grand Island, NEBRASKA 68803 3. The address of Original Contractor who is furnishing labor, service or materials for the construction of the improvements, is: 4. The name and address of each original contractor, presently known (after diligent inquiry) to the affiants, Owner or to Original Contractor, that is furnishing, or will furnish, labor, service, or materials, for the construction of the improvements, and the nature of such labor, service or materials, is as follows: *see List of Contractors and Suppliers 5. Work on the improvements actually commenced on ,7 at 8 : o'clock /1M. 6. This affidavit has been jointly made by Owner and Original Contractor by and through an authorized representative of each, the same being the undersigned affiant, and may be recorded by any person with the county clerk of the county in which the Property is located, whereupon it shall be deemed to have been jointly filed by Owner and Original Contractor. 7