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<br /> JNSTRUGTIQNS:
<br /> (�J If tfie licn , is cl4inred by a firm ns corporafian, sfat¢ here 11�at aJf'rant i.r a onemLer o/ the fisxn or his
<br /> u(j�cinE , copatity in tlec cornr�ratian.
<br /> ' (2) Slata here whelhec yerbal or :uri1len cotstract. If wriften attnch cop �
<br /> , y, ar lien u zroid_
<br /> r (3J "E�ecticrn;'•' •`Co�struction,•• "A!leration,» os •`Repnsr;' as tJ�e case may be.
<br /> (./) J{ere isuant corcect, legal descsiptioa o� las�d.
<br /> 15J Jf ths tabor aa�d materiai were iumished the coxtrdclor and not !he oxvner direcY, staR¢ "that.... ..............
<br /> ' svas the contracrlor on 'taid bnilding and aclin� Jor 7he rrtcmcr.^
<br /> (6) I/ uote has becm givex, say "aai8 amount it . furtAer evidenced by a p�veaissory nole, a copy oj sard „ote
<br /> beiwg hereto attuched a�rd »��ked 'Exhibi0 1�:"'
<br /> i
<br /> STA1:E OF NEBRASKA )
<br /> ) SS
<br /> COIJNITY OF SUFFALO )
<br /> I , Jeffrey L . Orr , Attorney for Anderson , Ina . i� � Kearnev ,
<br /> Nebraska , a£ter being first duly swom , depose and sa_y that I have
<br /> served notice of the filing of tna. s Mechanics Lien on Laxrv C . and
<br /> c:heryl A . Glazier , at 42b4 Utah Avenue , �;rand Island , Nebraska 68801 ;
<br /> and on Century Builders , at 23U4 Vilcing Court , c;rand Island , *Iebraska.
<br /> : 68801 , bX certified United States , nostaae nrenai . '
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<br />' Suhscribed and swom b ore r.me this 6th day o� Anril ,
<br /> 1978 _
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<br /> My Commission Expires :
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