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Return To: <br />Kim Osborn <br />Weathercraft Co of North Platte <br />PO Box 1949 <br />North Platte, NE 69103 <br />(308) 534-3480 <br />2. The person against whose interest in the real estate the lien is claimed is: <br />Grand Island Hospitality LLC <br />3. The name and address of the claimant is: <br />4. The name and address of the person with whom the claimant contracted is: <br />Vipul Barot 507 West 2nd St Grand Island, NE 68801 <br />Installed roof on motel <br />6. (Complete one' of the following) <br />• <br />Construction Lein <br />j - State 01 Nebraska <br />KIM OSBORN <br />My Comm. Exp. October 31, 2018 <br />1. The real estate subject to this lien is: Original Town Lots 1 & 2 <br />Block 83 Original Town, New City of Grand Island, Hall County Nebraska <br />Weathercraft Co Of Nvrth Pfatte DCA'Du'ff Roofing , PO Box 1149, North Platte, Nebraska 69103 <br />5. A general description of the claimants services performed to, materials furnished for the <br />improvement and the contract price is: <br />X 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 />X The time the last services or materials were furnished was: 9/9/16 <br />The time the last services or materials were furnished has not yet occurred but is estimated to occur: <br />Signature of Claimant Scott Erickson <br />Weathercraft Co of North Platte <br />State of Nebraska <br />County of Lincoln r� <br />On this ` day of , �f // , before me a Notary Public it <br />and for said county, pers Ily ca e c_ `/G Snn to me <br />known to be the identical person or persons who executed the foregoing release, and <br />acknowledged the same to be his, her, or their voluntary act and deed. <br />Witness my hand and seal in said county, the day and year last wr.ten abov <br />1/77 Public <br />CD <br />N <br />C7 <br />r' C'D <br />as <br />— c <br />CD <br />u ✓ CO <br />Q <br />` i 7 ;396.30 <br />