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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, Mike Hansen, being duly sworn, state the following: <br />cn <br />cn <br />N <br />r rt <br />1J i> F <br />ca r_ z' <br />f._ <br />c. <br />CD <br />CI1 <br />K1.21 CO <br />(!) <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: 1616 W Stoney Park Rd, Grand Island, NE <br />68801 , and legally described as: Lot Four (4), Block One (1), Farmington Second Subdivision, in the City <br />of Grand Island, Hall County, Nebraska which property is owned by Gerald Beck , whose address is <br />1616 W Stolley Park Rd, Grand Island, NE 68801 , of a total value of $ 10,654.00 , of which there <br />remains unpaid $10,654.00 , and I further state that I furnished the first of the items on the date of <br />October 4, 2020 , and the last of the items on the date of October 30, 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 />7)Ake )\e5- <br />Signature of Person Claiming Lien <br />Subscribed and sworn before me this <br />Seal <br />ON 'OMEN <br />Y 11 1 1t.L. kztylSP v- / C�Y�1 vrnt< L1 h (-& go(A vel v (-- <br />Of White Castle Roofing & Contracting plvechvs <br />Name & Title of Person Claiming Lien <br />GENERAL NOTARY -State of Nebraska <br />NICOLE CLARKE <br />My Comm. Exp. August 22, 2022 <br />day of tftovut \ , I . <br />Notary Signature <br />