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202103995 <br />The name and address of the owner or lessee <br />designee is: Name: Exchange Bank <br />Address: 3110 2nd Avenue, PO Box 397, Kearney, NE 68848 <br />The name and address of the general contractor, if <br />any, is: <br />Name: Clevenger Construction <br />Address: P.O. Box 334, Shelton, NE 68876 <br />WARNING TO THE <br />HOMEOWNER <br />YOU ARE REQUIRED TO DO THE FOLLOWING: <br />1. COMPLETE AND RETURN THIS FORM TO THE PERSON WHO ASKED FOR IT <br />WITHIN TEN DAYS AFTER THE DATE OF POSTMARK ON THE REQUEST. <br />2. IF YOU DO NOT COMPLETE AND RETURN THIS FORM WITHIN THE TEN DAY <br />PERIOD, YOU HAVE TO PAY THE EXPENSES INCURRED IN GETTING <br />THE INFORMATION. <br />3. IF YOU DO NOT LIVE AT THE SITE OF THE IMPROVEMENT, YOU MUST POST A <br />COPY OF THIS FORM INA CONSPICUOUS PLACE AT THAT SITE. <br />YOU ARE NOT REQUIRED TO BUT SHOULD DO THE FOLLOWING: <br />1. COMPLETE AND POST A COPY OF THIS FORM AT THE PLACE WHERE THE <br />IMPROVEMENT IS BEING MADE, EVEN IF YOU LIVE THERE. <br />Kevin L Johnson Date <br />This instrument was prepared by: <br />Exchange Bank <br />3110 2nd Avenue, PO Box 397 <br />Kearney, NE 68848 <br />Return to: <br />Exchange Bank <br />3110 2nd Avenue, PO Box 397 <br />Kearney NE 68848 <br />( <br />Andrea C Johnson Date <br />State of NEBRASKA <br />SS: <br />County of BUFFALO ++ )1/41 <br />The g instrument was acknowledged before me this 1 1 day of <br />, by Kevin L Johnson and Andrea C Johnson, Husband and Wife <br />Witness my hand and notarial seal at <br />Commission Exp <br />es <br />GENERAL NOTARY- State of Nebraska <br />DEBRA A. YOUNG <br />My Comm. Exp. July 24, 2023 <br />Notice of Commencement <br />raska in said • unty, the date aforesaid. My <br />