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4 <br />nn <br />m = D <br />°0 C n 2 <br />c?) <br />_ mix, <br />in0 <br />co <br />0 <br />c3) U <br />w r ')U <br />2� fi <br />r <br />0.0 0 CONSTRUCTION LIEN <br />DATE: W r January 14, 2019 <br />LIEN CLAIMED BY: <br />LIEN CLAIMED AGAINST: <br />STATE OF NEBRASKA ) <br />) ss: <br />COUNTY OF HALL ) <br />GB3customs & SSdesigns, LLC <br />1811 No. Lafayette Avenue <br />Grand Island, Nebraska 68803 <br />Travis T. Stephens <br />2121 Lamar Avenue <br />Grand Island, Nebraska 68803 <br />George E. Burgess, 111, member of GB3customs and SSdesigns, LLC, being first <br />duly sworn upon oath deposes and says: <br />1. He is a member of GB3customs and SSdesigns, LLC, and as such <br />verifies this account in writing for and on behalf of GB3customs and SSdesigns, LLC. <br />2. GB3customs and SSdesigns, LLC provided labor and materials on <br />property legally described as follows: <br />Lot One (1), in M & S Subdivision in the City of <br />Grand Island, Hall County, Nebraska <br />3. The date that the labor and materials were last furnished to said property <br />at the request of Travis Stephens, the owner of the above property, was on or about <br />September 22, 2018, and the price for these materials and services was Three <br />Thousand Five Hundred Dollars ($3,500.00). GB3customs and SSdesigns, LLC has <br />received no payment from Travis T. Stephens. <br />4. GB3customs and SSdesigns, LLC claims a lien on the above-described <br />real estate for the full amount of the contract price of Three Thousand Five Hundred <br />Dollars ($3,500.00), together with interest thereon at the rate of 16% per annum from <br />and after September 22, 2018. <br />GB3CUSTOMS AND SSD GNS, LLC <br />E. Burgess,rini <br />m <br />ber <br />Subscribed in my presence and sworn to before me by George E. Burgess, III, <br />personally known to me this 14th day of January, 2019. <br />GENERAL NOTARY - S:ate of Nebraska <br />DEBORAH S. CLEARy <br />My Comm. Exp. July 25, 2019 <br />Cti,-t,c,) <br />Notary Public <br />rn <br />v <br />N <br />Q <br />N <br />CD <br />C <br />XI <br />rn <br />w � <br />w —1 <br />0 <br />Id <br />C) <br />0 <br />