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A�� <br />CONSTRUCTION LIEN <br />RETURN TO: GERHOLD CONCRETE COMPANY - 2625 S. 158TH PLAZA, OMAHA, NE 68130 <br />1. The real estate subject to this lien is: WASHINGTON TWP N PT 1/4 SE 1/4 4-10-9 1.39 AC — <br />04776 S LOCUST STREET, GRAND ISLAND, NE 68801, HALL COUNTY, NEBRAKSA <br />2. The person against whose interest in the real estate lien is claimed is: MEDINA- <br />DELGADO/CARLOS, LISANDRA MOLINA-CRUELLS <br />3. The name and address of the claimant is: GERHOLD CONCRETE COMPANY, 2625 S. 158TH <br />PLAZA, OMAHA, NE 68130 <br />4. The name and address of the person with whom the claimant contracted is: AE CONSTRUCTION — <br />3892 S LOCUST STREET, GRAND ISLAND, NE 68801, HALL COUNTY, NEBRASKA <br />5. The General description of the claimant's services performed, to be performed, or materials furnished <br />or to be furnished for the improvement and the contract price is: CONCRETE OR CONCRETE <br />MATERIALS PLUS 18% ANNUAL INTEREST UNTIL ACCOUNT IS PAID $2671.85 <br />6. (Complete one of the following): <br />X The amount unpaid, whether due or not, to the claimant for services and/or materials is: <br />$2671.85 <br />The unpaid amount is not fixed by the contract, but a good faith -estimate in the amount of: <br />7. (Complete one of the following): <br />X The time of the last service or materials were furnished was: <br />6/19/2021 <br />The time the last services or materials were furnished has not yet occurred but is estimated to occur <br />BrianWitthuhn <br />Controller <br />GERHOLD CONCRETE COMPANY <br />STATE OF NEBRASKA) <br />)SS <br />COUNTY OF DOUGLAS) <br />The foregoing instrument was acknowledged before me of this 11TH day of OCTOBER, 2021 Brian <br />Witthuhn, Controller of Gerhold Concrete Company on behalf of said corporation. <br />My commission expires: FEB 15, 2025 <br />TRACY L CAPUTO <br />General Notary - State of Nebraska <br />My Commission Expires Feb 15, 2025 <br />