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r <br />Z <br />IV <br />0 x <br />e rr N • <br />CO 7C Z <br />C) <br />Cn <br />Claimant Name Shawna Humble of A -R Roofing LLC <br />Complete Address 40100 N HWY 281 Pratt, KS 67124 <br />Claimant Telephone 620 - 672 -2999 <br />LIENS, MECHANICS AND MATERIAL LIEN <br />Name of Owner <br />Name of Contractor <br />Name of Claimant <br />State of Kansas, Pratt County, ss: <br />David Kenkel <br />A -R Roofing LLC <br />Shawna Humble of A -R Roofing LLC <br />ARLEP GARLAND <br />Notary Public - State of Kansas <br />My Appt. Expires 6?„ -- /i <br />STATEMENT by Any Person Under Contract with the Owner, Etc., for Labor or Material, Etc. <br />Said Contractor and Claimant claims a Lien upon the following- described property, to -wit: <br />Woodland Park 1st Sub Lot 2 Block 1 in the City of Grand Island, Hall County, Nebraska <br />Commonly known as: 4182 New Mexico Ave Grand Island, NE 68803 <br />For that A -R Roofing LLC did under contract with David Kenkel, owner of the property aforesaid perform labor and furnish material <br />for removal and replacement of roof on house in and upon said property. <br />The amount claimed for said labor and material is $00.00 0 and said labor and materials and the items thereof, as nearly as <br />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 3rd day of September, 2015. <br />That all of said material was used and labor performed in the erection and construction of said above -named improvements. <br />1 \QMMO.. L <br />Shawna Humble of A -R Roofing LLC Claimant <br />Notary Public <br />r <br />Shawna Humble of A -R Roofing LLC, of lawful age, being first duly sworn, upon oath, says: That he is the claimant mentioned in the <br />foregoing Statement of Mechanic's Lien; that he had read said statement and knows the contents therof; that the name of the <br />owner, name of the contractor, the name of the claimant, the description, of the property upon which the lien is claimed, and the <br />items of the account as therin set forth, are just, true, and correct. <br />Subscribed and sworn to before me this JP day of ■a_n p�... 20 <br />My commission expires:c4-Pc -- / (o <br />rrt <br />rri <br />i C <br />CIi <br />C./3 <br />CO <br />co <br />_tea <br />ITT <br />