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223 CONSTRUCTION LIEN Jacob North Printing Co., Inc. Lincoln, NE 68524 <br />M r l r ) <br />7_ D <br />M cn <br />r) <br />a C A N <br />\ ` -�.j o coy{ <br />VID d CD =1 <br />Q E t� <br />M co <br />CD N <br />J o Ce • <br />4W <br />200108124 <br />CONTRACTING OWNER OR SUCCESSOR IN <br />INTEREST: REAL ESTATE: r <br />-- - - -tl! .r..- f ..... e- .fe- -- ---------------------------- <br />(Name) .,,(,,� <br />---- - - - - -- - -� ---- - S.r- .l. -.J- ------------------------ <br />CLAIMANT: <br />Az ------ - - - - -_ <br />- -------------- a- - - - - -- �� n � � / Ana-------------------------------- - - - - -- <br />(Address) l V (� Q 3 <br />---------- %�a..,.,.� a �-; - - - -- - -- -- <br />------------------------------------------------------------------------------- <br />(Phone) <br />S----- - - - - -- <br />(Legal Description) <br />- - -V IRA- -------- 14 -. t. J-------- A.dd - - -► t.1- ad--- ---- - - - - -- <br />CLAIMANT CONTRACTED WITH: <br />- Pu --------- - - - - -- ----------------------------- <br />(Name) ' <br />--------------- - - - - -- <br />(Address) t� ) <br />---------- - - - - -- -- ----- Can - -------- <br />---- - ---------------- - --- -- .. --------------------------------------------------------- <br />(Phone) <br />SERVICES OR MATERIALS FURNISHED BY CLAIMANT: ...... ... ... ... ...._._... -.--.--._....-........._._.__------...___-_.-------._.-.--_- <br />p d <br />------------------------------------------------------------------------------- - - - - -- --------------- - - - - -- -- - - - - -- - -- ------------------------------------------------------ -------------------------------- <br />------------------- - - - - -- ---------- -- - - - - -- ------------------------------- - - - - -- -------------------- - - - - - -- ---------------------------------- - - - - -- -------------------------------- - - - - -. . <br />CONTRACT PRICE: $... - AMOUNT UNPAID: $ j - -- ---, <br />TIME LAST SERVICES OR MATERIALS FURNISHED: -------------- ----------------------- ----------------------------------------------------------- -- ... - - -- <br />State of -... �.C�'l4!4a1 ss.0 <br />- <br />/Y- GCX ------ - - - - -- ----County Signature of Claimant <br />On this -- - - -13- ------- - - -- day of ------- ------ --------------- - - - - -- ....... , 001.. , before me a Notary Public in and for, <br />00-1) r � <br />said county, personally came .........- -. - - -. 1 -� /(- YI- f. 1r--- -------------------- -- -- --- --- to me known to be the identical person on <br />persons who executed the foregoing instrument, and acknowledged the same to be his, her, or their voluntary act an <br />deed. _ <br />69HiAt. NOTARY -SW Of Nebraska <br />dACCAJ WN I POUJOCK ---- - -- ----- ----- 2 -- - - - -------- -------------------------- <br />My COOL ft ,AtIt20% Notary Public. <br />My commission expires the ----- .....IT-ou ------- day of......P-- . _- .-- __...- ..- - -. -¢� <br />STATE OF ...................................... ................... .. .. ....... Entered on numerical index and filed for record, <br />ss. <br />County of -------------------------- ----------- -------------------- ----- -- -- -- -- in the Register of Deeds Office of said County thrl <br />--- - - - - -- - - - -- --day of - - -- ................ ------------- - - - - -> --- - - - - -- - -> at -------------------------------- - - - - -- o'clock and - - - -- ------------------ minutes .... .------------- <br />M. <br />andrecorded in Book - ------------------------ - - - -of ------------------------- - - - -at page------------------------- - - - - -- <br />---------- -- ----------------------------------------------------- - - - - -- - - - -- -Reg. of Deeds <br />By--------------------------------------- - - - - -- --------------- - ----- ------- ----- - - - - -- Deputy <br />