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C <br />Z <br />t uu <br />CONSTRUCTION LIEN <br />State of Nebraska <br />County of Hall <br />Subscribed and sworn to before me this' 5 day of 0G+OtOc ,2015 <br />1' <br />cn <br />CO <br />cn <br />c� <br />1. The real estate subject to this lien is : Hurley Sub Lot one (1) n 4raM.zi an.d, 4411 &Junk( t 44 7 <br />2. The person against whose interest in the real estate the lien is claimed is :Janet Bose <br />� 3. The name and return address of the claimant is: PDR of Central Nebraska Inc, D /B /A Paul Davis <br />Restoration, 438 Industrial Lane, Ste E Grand Island, NE 68803 <br />4. The name and address of the person with whom the claimant contracted is: Janet Bose 523 E 1 St, <br />Grand Island, NE 68801 <br />5. A General description of the claimant's services performed to, to be performed or materials furnished <br />or to be furnished for the improvement and the contract price is: Fire restoration repairs to structure <br />and cleaning and inventory services to property /contents due to fire that occurred on or around <br />05/24/2015. <br />6. The amount unpaid, whether due or not, to the claimant for the services or materials is: $16,390.95 <br />7. The time the last services or materials were furnished was : 07/15/2015 <br />PDR of Central Nebraska Inc <br />D /B /A Paul Davis Restoration <br />By Nick Suminski /General Manager <br />Signature of Claimant <br />Notary Public <br />