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Return to: Neuhaus Law Office POB 1685 Grand Island, NE 68802 -1685 TO: FRANK AND JOAN HERMES 1923 W. DIVISION GRAND ISLAND, NE 68801 STATE OF NEBRASKA ) ) ss. COUNTY OF HALL ) R1 L • 7. VI CONSTRUCTION LIEN, NOTICE AND PROOF OF SERVICE Affiant, Brad Henke, President of XYZ Exterminating, Inc. being duly sworn upon oath, states: 1. The real estate which is the subject of this lien is located at 1923 W. Division, Grand Island, Nebraska, legally described as follows: Northerly Seventy - Two (72') of Lot Five (5), Block Fifteen (15), Charles Wasmer's Addition to the City of Grand Island, Hall County, Nebraska. 2. The name of the persons against whose interest in the real estate a lien is claimed is Frank and Joan Hermes, 1923 W. Division, Grand Island, Nebraska. 3. The name and address of claimant is: XYZ Exterminating, Inc., P.O. Box 1643, Grand Island, NE 68802. 4. The claimant contracted Frank and Joan Hermes, owner of the above - described property. 5. A general description of the services performed, or to be performed, or the materials furnished, or to be furnished for the improvements are as follows: provide termite extermination services to the premises. 6. The work, labor, skill and materials were done and performed and furnished by XYZ Exterminating, Inc., for the providing termite extermination at the premises in the above - described real estate for a total charge of $856.00. A copy of the statement is attached hereto as Exhibit "1" and made a part hereof by reference. 7. At the time said labor and materials furnished, Frank and Joan Hermes, were the record owners of said premises according to information conveyed to your Affiant. The date the materials provided or furnished was December 15, 2015. m rn co rti? CD Cj) C7D CD r CD-