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IV , z <br />B <br />cri <br />°_ en N <br />0 <br />a <br />Return To: <br />Kim Osborn <br />Weathercraft Co of North Platte <br />PO Box 1949 <br />North Platte, NE 69103 <br />(308) 534-3480 <br />1. The real estate subject to this lien is: Cairo Mayfield Village First ADD <br />BLK 2 Lot 7 Parcel ID# 400170620 <br />2. The person against whose interest in the real estate the lien is claimed is: <br />Karon Rath <br />3. The name and address of the claimant is: <br />m <br />-n <br />Construction Lein <br />fl n <br />Weathercraft Co Of North Platte, DBA Duff Roofing PO Box 1949, North Platte, Nebraska 69103 <br />4. The name and address of the person with whom the claimant contracted is: <br />Karon Rath 511 S Alexandria, NE <br />5. A general description of the claimant's services performed to, materials furnished for the <br />improvement and the contract price <br />Reroof residence <br />6. (Complete one of the following) <br />X The amount unpaid, whether due or not, to the claimant for the services or materials is: $ 671.04 <br />The unpaid amount is not fixed by the contract, but a good faith estimate in the amount of: $ <br />7. (Complete one of the following) <br />X The time the last services or materials were furnished was: 9/15/14 <br />State of Nebraska <br />County of Lincoln <br />Subscribed "and , sworn to before me this <br />Signature of Claimant'( - &)Ck5cr <br />Weathercraft Co of North Platte <br />day ofLb £ 2007 <br />� un�L� <br />Notary Public <br />The time the last services or materials were furnished has not yet occurred but is estimated to occur: <br />