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2 D GO <br />m N CO <br />( N. T 1 - = -, rU <br />F -a ry <br />r— Q <br />c J 1--+ <br />-n <br />CD OD <br />CD CD CO <br />V) <br />Requested by: Mike Hansen <br />When Recorded Mail to: <br />Name: White Castle Roofing Phone number: 402-423-1796 <br />Address: P.O. Box 22405, Lincoln, NE 68542 <br />Claim of Construction Lien <br />State of Nebraska <br />County of HALL <br />I, Dane Hansen, being duly sworn, state the following: <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: 102 Solar Street, Alda, NE 68810 , and legally <br />described as: Lot One (1), Argo Third Subdivision, Hall County, Nebraska which property is owned by <br />Nicole Orr/Thornton , whose address is 102 Solar Street, Alda, NE 68810 , for work authorized by <br />Michael Thornton on your behalf, a total value of $ 9958.78 of which there remains unpaid $9958.78 , <br />and I further state that I furnished the first of the items on the date of August 7, 2020 , and the last of <br />the items on the date of August 25, 2020. <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 />fare of Person Claiming Lien <br />dianSeh G E 0 <br />Of White Castle Roofing & Contracting <br />Name & Title of Person Claiming Lien <br />Subscribed and sworn before me this day of DQCe,Ywi o -PN, 0a0 • <br />el )) <br />Seal <br />GENERAL NOTARY -State of Nebraska <br />NICOLE CLARKE <br />My Comm. Exp. August 22,2022 <br />Notary Signature <br />ON 1N3Wfl 1SN1 SV QJI31N3 <br />