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Construction Lien Return To: Name: Vince Mendez /Personal Construction Address: 2404 W Old Lincoln Hwy City, State, Zip: Grand Island, NE 68803 Phone: 308 - 293 -1621 The real estate subject to this lien is: L-\.°1-\ l:)1\V\ (1\'A -1 5 .NN. 1\ -%. \31 \ - \ -- \\ "15\14 1. Grand Island, NE 68803 Nab\ C.ov r , �y, 0 2. The person against whose interest the real estate the lien is claimed is: Brenton Kasselder 3. The Name and address of the claimant is: Vince Mendez, 2404 W Old Lincoln Hwy, Grand Island, NE 68803 4. The Name and address of the person with whom the claimant contacted is: Brenton Kasselder, 1428 N Lafayette Ave. Grand Island, NE 68803 5. A general description of the claimant's service performed to materials furnished for the improvement and the contract price is: Supplies, Parts and Labor on the House, Property and Vehicles 6. (Complete one of the following) X The Amount unpaid whether due or not to the claimant for the services of materials is: $ 9,323.84 The unpaid amount is not fixed by the contract, but a good faith estimate is the amount of: $ 7. (Complete one of the following) _ X _ The time last services or materials were furnished was: 12/25/2015 The time the last service or materials were furnished has not yet occurred but is estimated to occur: Signatur aimant Personal Construction State of ,� County of 5a4...?-4-- On This /9' day of , Xi ' 7 , before me a Notary public in and for said county, personally came ' - 1 . g i- T. *wito me known to be the identical person or persons who executed the foregoin�se, and acknowledged the same to be his, her, or their voluntary act and deed. Witness my hand and seal in said county, the day and year last written above. NOTARY STAMP (Affix Official Notary Seal) GENERAL NOTARY - State of Nebraska DENICE R. KRUSE My Comm. Exp. September 25, 2018 v061440) Signature Notary Public 201707087 1 2( -3xL'