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145 - CON PTRUCTIION LIEN M Jacob North Printing Co., Inc., Walton NE 68461 <br />C= M Cn <br />C-) (f) <br />O CD <br />C) —4 <br />C= r, <br />m -J CD <br />< C11 <br />1710 C) M <br />C=) <br />C, <br />CJq <br />CD <br />CONSTRUCTION LIEN OD <br />04 <br />/7 <br />1. The real estate subject to this hen is: 44 <br />> <br />2. The person against whose interest in the real estate the lien is claimed is: z L <br />3. The name and address of the claimant is: <br />4. The name and address of the person with yv om the claimant contracted is: <br />5. A general description of the claimant's services performed to, to be performed or materials furnished or to be <br />furnished for the improvement and the contract price is: <br />6. (Complete one of the following) <br />-XN- The amount unpaid, whether due or not, to the claimant for the services or materials is $ <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 />The time the last services or materials were furnished was <br />The time the last services or materials were furnished has not yet occurred but is estimated to occur <br />Signature of daimant <br />day Of <br />Subsribed and sworn to before me this L1 agEg� <br />A <br />TERESA A. sTAWSTKA Notary Public <br />my Conan. Ev. thy , r ,.4 <br />(52-147. See 52-148 for amendment; 52-149 for assignment; 52-137 for recording time; 52-154 for discharge or release). <br />