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223_ CONSTRUCTION LIEN Jacob North Printing Co., Inc., Lincoln, NE 68524 <br />A C1 <br />k . -n I = D 2001 <br />m CA 0784 2 <br />} n = <br />= n <br />M Vr <br />Z p <br />CD co <br />_ <br />�P B E <br />r - <br />;v rr, <br />GA WELLED` U <br />r 71 <br />-11 El <br />CD <br />> <br />CA o �� <br />tft7 <br />2 0 0 <br />CONTRACTING OWNER OR SUCCESSOR IN <br />INTEREST: REAL ESTATE: <br />Pu �_ L- = 1 T <br />'� - - -- ....L� �(-- 1�.....- ..51 <br />I (Name) Q I �T <br />------ - - - - -- © 04 Jo, 6-,-w 6j --- - - - - -- (Legal Description) <br />� <br />-5 e ------------------ ---- --..._ - -- - - -- <br />CLAIMANT: CLAIMANT CONTRACTED WITH: <br />andy S-evy <br />------ - - -r-- r -n - - -- ! � � 11 -------- i —C-f r� i <br />l.f:. <br />(Name) .) (Name) 'c <br />_ <br />........... . . . . .. .� - -� r a v" C --------- .. - - - -- - -- - - - - -- -- - - -2.0 T ..5 - -o....... G-CA--r.—A-5 .- -- <br />(Address) '•/ (Address) + ^j <br />------- ------ ----- r� =� r� F� i ��:- f -. - :..-6-1-2 -3 - - - -- --- - - - - -- 5 . t7- 01 .06... s -\ 0.1' & L.1 ---------- - ---- - - - - -- <br />�� �^ ---- - - - -_. ------------------ ----- -------- - 1-3-14 - <br />(Phone) (Phone) <br />1 <br />SERVICES OR MATERIALS FURNISHED BY CLAIMANT- ---- -- - -- --- ---- - - - - -- .. -. -. -_ -- - - - - -_ --- - - - - --------------------------------- <br />I <br />- - - - -- - ----------- -------- �- n...... - b <br />-- - - - - -- 0 4 - - - -- 1� �� -A 03-v)-\"s !� �`- ti.c�s� - �..- .Q -r�1 .f�.0 <br />s <br />s <br />CONTRACT PRICE: $ -.- ..0.-- `- - -(p -� -, -- .... AMOUNT UNPAID: $ - -.. �"1 -- o -- -- -....! <br />TIME LAST SERVICES OR MATERIALS FURNISHED: --- - - - - ---- 3-,. - -- <br />State of ..�r ' "..1 .... ....... . . . .. . . .. <br />ss /�� - m.�'... ..I. --- ----------------------- <br />--- - - - - --- ----- ------ - - - - -- County Signature of Claimant <br />On this ---- -..AA....... day of --- - - - - -- (L-11 . -.------------------------------ aG © -� - -- ,before me a Notary Public in and for <br />i nn <br />said county, personally came - - - -- alUdd R.... 1 ICAIC.nr- r ......... . . . . . .. to me known to be the identical person oil, <br />j persons who executed the foregoing instrument, and acknowledged the same to be his, her, or their voluntary act an <br />deed. <br />�aaaiav -aura Ge&<k <br />JA001�N A POLL�OCK <br />Notary Public. <br />My commission expires the -------- -L <br />- -- -day of. - - - -- � - -- -- - � - -- <br />STATE OF - -- - - - - -- -- - - - - -- - - - - -- <br />ss. Entered on numerical index and filed for record <br />t County of ...................................... ............................... in the Register of Deeds Office of said County thej <br />i <br />i <br />I----------- - - - - -- ---day of . -- --------------------- - - - - -- ........ ------- - - - - -, at---- - - - - -- -- ............ .... o'clock and ......... ............... minutes - -- ......... - -.M. <br />and recorded in Book - - - - - -- - - - -- -of - - - -- ------------- - - - -at page----- - - - - -- --- - - - - -- <br />- - - -- - ----------- - -- - -- ---------- - - - - -- -- ----------- - - - - -- -Reg. of Deeds <br />BY-------------- - - - - -- . -- - -- ---....-------------------------------- -Deput <br />i <br />i <br />