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the date of t9q'1la a %Sr I hereby, under the laws of the State of / (44W- , claim a lien against the above - described property in the amount of money, stated above, which remains unpaid to me. Signature of Person Claiming Li Address of person claiming lien: G 700 ' NOTARY CERTIFICATION FOR CLAIM OF LIEN State of 121 - 1 ". County of On 1 44 /D 020 /6 (date), � "al-Lc �/ f (name of claimant), came before me per- / sonally, and duly sworn on oath, and under penalty of perjury, stated that he or she is the claimant described in the above claim of lien and that he or she has read the foregoing claim of lien and has knowledge of and personally knows the foregoing statement of claim of lien which he or she subscribed is true and correct and is not frivolous, nor clearly excessive, and is made with reasonable cause. Subscribed and sworn to before me on the above noted date by the above noted claimant, and proved to me on the basis of satisfactory evi- dence to be the person who appeared before me. Notary Signature Notary Public, In and for the County of State of My commission expires: D9- 5 a / v CERTIFICATE OF MAILING I, C. 6N/i7r SONOL/ , certify that on this date, c:2 - 02 0/S , I have mailed a copy of this Claim of Lien by USPS certified mail, return receipt requested, in accordance with the law, to: Name: /�i A/ E' 41S',9- POOL Address: 2O /. LA // Gf 4w.0 _7 .44ND 60°-3 Date: c 2 /O X20 S ignature of Person fL J tkO'I� /t//,v ), 1;19 6-6-3 4 7Y S �� /t/6-8, ( 7% qq 201500844 )/ V, 6 E /L sv/viel 6L Name of Person Claiming Lien // ailing Claim oJ' ien Name of Person Mailing Claim of Lien c 2 LrND/`r SUii/DL //*- GENERAL NOTARY - Ste of Nebraska DENICE R. KRUSE *Comm. Exp. September 25, 2018 *NOVA LF136 Claim of Lien Pg.2 (07 -11)