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Requested by: Mike Hansen <br />When Recorded Mail to: <br />/Name: White Castle Roofing Phone number: 402 - 423 - 1796 <br />V Address: P.O. Box 22133, Lincoln, NE 68542 <br />State of Nebraska <br />County of Hall County <br />I, Mike Hansen, being duly sworn, state the following: <br />Signature of Person Claiming Lien <br />Seal <br />1 <br />GENERAL NOTARY -State of Nebraska <br />PAMELA TROUPE <br />My Comm. Exp. September 17, 2018 <br />0) <br />Name of Person Claiming Lien <br />N ) <br />CJ'1 <br />t <br />CD <br />In accordance with an agreement to provide labor and /or material, I did furnish the following labor <br />and /or materials: Roofing & gutter materials and labor on the following described real property located <br />in Hall County, State of Nebraska, commonly known as: 1018 W 1st St, Grand Island, Nebraska <br />68801 , and legally described as: COUNTY SUB 16 -11 -9 W 118' X 132' LT 2 & FR LT 6 W OF E 14' OF LT 6 BLK 120 <br />KOENIG & WIEBE'S ADD . which property is owned by John Bartel , whose address is 1018 W 1st St, <br />Grand Island, Nebraska 68801, of a total value of $ 22,033.75 , of which there remains unpaid balance <br />of $ 6,288.07 , and I further state that I furnished the first of the items on the date of August 8, 2017 , <br />and the last of the items on the date of October 3, 2017 . <br />I hereby, under the laws of the State of Nebraska, claim a lien against the above - described property in <br />the amount of money, stated above, which remains unpaid to me. <br />t..,_... M ; I - e -e5C <br />Subscribed and sworn before me this /9 day of ." —t '1a a ry , <br />Notary Signature <br />