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tzt- <br />�, -,y1� U) <br />w4 <br />CD <br />m <br />C-- a <br />y <br />cv <br />-c <br />W _. <br />m <br />N v <br />f- <br />(7 -,n <br />C=) <br />N <br />co <br />-n = <br />C:) <br />Cn <br />= M <br />o <br />M <br />--=q <br />r— D <br />S <br />C <br />.0 <br />cf) <br />F. a <br />Cn <br />CJ 1 <br />O <br />Q <br />O' <br />M <br />200004131 <br />A136 -10 CLAIM OF LIEN <br />State of Nebraska <br />County of Hall SS. <br />May 19 <br />��._� � <br />�, -,y1� U) <br />w4 <br />CD <br />rn <br />C-- a <br />ry <br />cv <br />-c <br />m <br />M <br />a <br />f- <br />(7 -,n <br />C=) <br />co <br />-n = <br />C:) <br />Cn <br />= M <br />o <br />CIO <br />--=q <br />r— D <br />S <br />C <br />.0 <br />cf) <br />F. a <br />Cn <br />CD <br />Q <br />, 192000 <br />Before me, the undersigned Notary Public, personally appeared /-1 -UGC &tj- <br />who duly sworn says that he is (the lienor herein) (tlW4W1W9*A1&76r -1WNA) <br />(Delete One) <br />Progressive Engineered Components <br />(Lienor's Name) <br />whose address is 1913 East Citation Way, Grand Island, Ne. 68801 <br />(Lienor's Address) <br />. A� <br />and that in accordance with a contract with John Bellamy And Or Bellay on <br />wat ' <br />lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials separately) <br />1 54' Post Frame Truss $350.00, 7 12'3" 2Ply Headers $581.00, lUnit 2X6 18' SYP <br />128 Count $1,130.24, 1 Unit 2X8 SYP 128 Count $1,092.61, & Sales Tax $189.23 <br />on the following described real property in Hall County, State of Nebraska <br />(Describe real property sufficiently for identification, including street and number, if known) <br />309 Gold Rd., Lot 2, Westgate 6th Sub. <br />owned by <br />John Bellamy,Bellamy Construction <br />of a total value of Three Thousand Three Hundred Fourty Three . O &llars ($ 3,343.08 <br />) <br />of which there remains unpaid $__I, , 343.08 <br />and furnished the first of the items on <br />1/24/2000 , 19 and the last of the items on 1/24/2000 , <br />and (if the lien is claimed by one not in privity with the owner) that the lienor served his notice to owner on <br />5/1��2gnn , 19 , by United -hates Mail <br />(Method of Service) <br />APHE <br />o 53926 20053 5 <br />Q <br />