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145 - CONSTRUCTION LIEN Jacob North Printing Co., Inc., Lincoln, NE 68524 <br />�r\>8111111111.1111 <br />awnsms� <br />W CONSTRUCTION LIEN <br />1. The real estate subject to this lien is: <br />l �{%1CS�KfhtrI,toneh\�u>r No✓tkz,-1A(5.NYc..)0;`10+tc-cn& <br />1^LAn �J Gt ✓� rtherl.(u'.Cina1E`,c 1�?o.lthA�r1�(on WeVz.13YL�uccoosta.A 43,4'. \ 4a•0k 1 r,g 1�� a� ►Z lir td.ct„� H t3wns ��f 4,_p <br />1sJork6r Koln7/, Ne(1rska <br />2. The person against whose interest in the real estate the lien is claimed is. C <br />A v i (g M .`l11 a ( v14 r,, Y.2GSrc- e.a)-e-✓ &CJ_ <br />3. The name and address of the claimant is: 1 to %.PlAD}- A bAil v tt' t cc, n <br />rs <br />4. The name and address of the person with whom the claimant contracted is. ( <br />5. A general description of the claimant's services performed to, tq be performed or materials Furnished or to be <br />furnished for the improvement and the contract price is• j\l u ) c f ocTe u, v4'.cJ c..¢ -C] <br />Co � C—(o r (c 5-4* Tib h)- LkS.sz- 3O N - <br />6. (Complete one of the following) <br />XThe amount unpaid, whether due or not, to the claimant for the services or materials is $ 9 9`50 0 <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 />The time the last services or materials were furnished was :� -1'" aU a I <br />The time the last services or materials were furnished has not yet occurred but is estimated to occur <br />Subscribed and sworn to before me this <br />.l• <br />Signature of Claimant <br />30 <br />sraIEFAL 4l9TAIW Step of P& ras a <br />ENERAL '0'TlitttYBi6I-f4. w;sita <br />[ kl�'Comm. Exp.'Apr6'3 2022 <br />.v <br />day of , o7% <br />Notary PulSlic <br />(52-147. See 52-148 for amendment; 52-149 for assignment; 52-137 for recording time; 52-154 for discharge or release). <br />n <br />PzI <br />1 1 <br />C7 <br />N <br />ONa:N3iMMN <br />Rev. 9/95 <br />