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Iv �� m 2 1' <br />• c n <br />0- al? <br />Claimant Name Kori Walker of A -R Roofing LLC <br />Complete Address P.O. Box 8712, Pratt, KS 67124 <br />Claimant Telephone 620 -672 -2999 <br />LEINS, MECHANICS AND MATEREIL MEN <br />STATEMENT by Any Person Under Contract with the Owner, Etc., for Labor or Material, Etc. <br />Name of Owner Dick R. Fieldgrove Jr and Pamela B. Fieldgrove <br />Name of Contractor A -R Roofing LLC <br />Name of Claimant Kori Walker of A -R Roofing LLC <br />Said Contractor and Claimant claims a Lien upon the following- described property, to -wit: <br />Lot 32, Capital Heights Seventh Subdivision, City of Grand Island, Hall County, Nebraska <br />Commonly known as: 4209 Nevada Avenue, Grand Island, NE 68803 <br />State of Nebraska, Hall County, ss: <br />Subscribed and sworn to before me this £- day of kQ a rwbPir, 20 1 j . <br />My commission expires: ,S _e- I G.) <br />Claimant (Kori Walker) <br />am <br />For that A -R Roofing LLC did under contract with Pam Fieldgrove, owner of the property aforesaid perform labor and furnish material for <br />removal and replacement of roof on house in and upon said property. <br />The amount claimed for said labor and material is $S861.09 (five thousand, eight hundred sixty one dollars and nine cents) and said labor and <br />materials and the items thereof, as nearly as practicable, are set forth in the bill of items hereto attached, made a part of this statement. <br />That labor was last performed and material was last furnished under said contract on the 22"d day of September, 2014. <br />That all of said material was used and labor performed in the erection and cons uction of <br />c� ) <br />r'' <br />C) - of <br />co <br />r <br />r <br />r rs <br />cn <br />7C <br />Cr) <br />Kori Walker of A -R Roofing LLC, of lawful age, being first duly sworn, upon oath, says: That he is the claimant mentioned in the foregoing <br />Statement of Mechanic's Lien; that he had read said statement and knows the contents therof; that the name of the owner, name of the <br />contractor, the name of the claimant, the description, of the property upon which the lien is claimed, and the items of the account as therin set <br />forth, are just, true, and correct. <br />Notary Public (Arlene Garland) <br />ARLENE GARLAND <br />wiel Notary Public - State of Kansas <br />My Appt. Expires , _ Q - /( <br />1 <br />©0 <br />